Background: Previous studies have often reported a link between advanced age and inadequate cancer pain management. Given Italy’s demographic profile as the country with the oldest population in Europe, it offers an ideal setting to explore whether this association remains valid today. Aim: This study aimed primarily to assess the influence of advanced age on the adequacy of pain management among patients receiving treatment in Italian radiotherapy (RT) departments, and secondarily, to identify age-specific determinants of analgesic undertreatment. Methods: In this prospective, multicenter study, we enrolled 2104 consecutive patients attending 13 RT centers between October and November 2019. Pain intensity was evaluated using the numeric rating scale (NRS), and patients reporting scores ≥ 1 (n= 1353) were included in the analysis. Pain management adequacy was assessed using the Pain Management Index (PMI), with negative values indicating undertreatment. A two-step statistical approach was employed: variable selection via Least Absolute Shrinkage and Selection Operator regression, followed by Classification and Regression Tree analysis to identify key predictors. Separate analyses were performed for the overall population, older adults (≥65 years), and younger adults (18–64 years). Results: Overall, 42% of patients were undertreated (PMI < 0), without significant differences between older (41.0%) and younger patients (43.1%). However, factors contributing to undertreatment varied according to age. For the entire cohort, non-cancer pain was associated with substantially higher rates of undertreatment (74.3%) compared to cancer-related pain (34.2%). Among cancer patients, those receiving curative RT had poorer pain control (49.4%) than those receiving palliative RT (28.8%). In older patients, geographic location strongly influenced pain management, with higher rates of undertreatment in central and southern Italy compared to the north (e.g., palliative RT: 64.0% vs. 15.4%, respectively). Conversely, younger patients showed no geographical differences; instead, timing of assessment (beginning vs. end of RT) influenced outcomes, with improved PMI values towards the end of treatment. Conclusions: Unlike previous studies, advanced age itself was not associated with inadequate analgesia. However, the determinants of inadequate pain management differed significantly by age: geographic disparities were predominant among older patients, while assessment timing influenced outcomes for younger patients. Further longitudinal research and targeted interventions are needed to address these age-dependent challenges.
背景：既往研究常报道高龄与癌症疼痛管理不足之间存在关联。鉴于意大利是欧洲人口老龄化最严重的国家，这为探究该关联在当今是否依然成立提供了理想的研究背景。目的：本研究主要评估高龄对意大利放疗科接受治疗患者疼痛管理充分性的影响，次要目的是识别不同年龄段镇痛不足的特定决定因素。方法：在这项前瞻性多中心研究中，我们连续纳入2019年10月至11月期间在13个放疗中心就诊的2104例患者。采用数字评分量表评估疼痛强度，将报告评分≥1分（n=1353）的患者纳入分析。使用疼痛管理指数评估疼痛管理的充分性，负值表示治疗不足。采用两步统计方法：通过最小绝对收缩与选择算子回归进行变量筛选，随后运用分类与回归树分析识别关键预测因子。分别对总体人群、老年患者（≥65岁）和年轻患者（18-64岁）进行分析。结果：总体而言，42%的患者存在治疗不足（PMI<0），老年患者（41.0%）与年轻患者（43.1%）之间无显著差异。然而，导致治疗不足的因素因年龄而异。在整个队列中，非癌性疼痛的治疗不足率（74.3%）显著高于癌性疼痛（34.2%）。在癌症患者中，接受根治性放疗者的疼痛控制不足率（49.4%）高于接受姑息性放疗者（28.8%）。老年患者中，地理位置对疼痛管理影响显著，意大利中南部地区的治疗不足率高于北部地区（例如姑息性放疗：64.0% vs. 15.4%）。相反，年轻患者未显示地域差异；但评估时机（放疗开始vs.结束）影响结果，治疗结束时的PMI值有所改善。结论：与既往研究不同，高龄本身与镇痛不足无显著关联。然而，疼痛管理不足的决定因素在不同年龄组间差异显著：地域差异在老年患者中占主导地位，而评估时机对年轻患者的结果影响更大。需要进一步开展纵向研究和针对性干预措施以应对这些年龄相关挑战。
肿瘤(癌症)患者之家