接受放射治疗患者的疼痛管理充分性：多中心ARISE-1研究的亚分析
Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study.
作者信息
Donati Costanza M, Maggiore Chiara Maria, Maltoni Marco, Rossi Romina, Nardi Elena, Zamagni Alice, Siepe Giambattista, Mammini Filippo, Cellini Francesco, Di Rito Alessia, Portaluri Maurizio, De Tommaso Cristina, Santacaterina Anna, Tamburella Consuelo, Di Franco Rossella, Parisi Salvatore, Cossa Sabrina, Fusco Vincenzo, Bianculli Antonella, Ziccarelli Pierpaolo, Ziccarelli Luigi, Genovesi Domenico, Caravatta Luciana, Deodato Francesco, Macchia Gabriella, Fiorica Francesco, Napoli Giuseppe, Buwenge Milly, Morganti Alessio G
机构信息
Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
出版信息
Cancers (Basel). 2023 Dec 25;16(1):109. doi: 10.3390/cancers16010109.
BACKGROUND
Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management.
METHODS
This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management.
RESULTS
A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; : 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; < 0.001).
CONCLUSIONS
In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.
背景
疼痛是癌症患者中普遍存在的症状，其管理对于提高患者生活质量至关重要。然而，转诊至放疗（RT）科室的癌症患者的疼痛管理往往不足，且针对这一特定人群的研究有限。本研究旨在评估患者转诊接受放疗时疼痛管理的充分性和有效性。此外，我们还探讨了充分疼痛管理的潜在预测因素。
方法
这项观察性、前瞻性、多中心队列研究纳入了18岁及以上转诊至放疗科室的癌症患者。使用疼痛管理指数（PMI）进行疼痛管理评估，该指数通过从镇痛评分中减去疼痛评分来计算（PMI < 0表示疼痛管理不足）。进行单因素和多因素分析以确定充分疼痛管理的预测因素。
结果
本研究共纳入1042例癌症门诊患者。分析显示，根据PMI值，42.9%的疼痛患者未得到充分的疼痛管理。在转诊接受姑息性或根治性放疗的疼痛患者或服用镇痛药的患者中，分别有72%和75%的患者镇痛治疗不足或无效。接受姑息性放疗的患者获得充分疼痛管理（PMI≥0）的几率更高（OR 2.52；<0.001），与癌症相关疼痛评分为1的患者相比，东部肿瘤协作组（ECOG）体能状态（PS）评分为2、3和4的患者获得充分疼痛管理的几率更高（分别为OR 1.63、2.23、5.31；P值分别为0.017、0.002、0.009），在意大利北部接受治疗的患者与在意大利中部和南部接受治疗的患者相比获得充分疼痛管理的几率更高（分别为OR 0.25、0.42；<0.001）。
结论
在本研究中，转诊至放疗科室的相当一部分癌症患者未得到充分的疼痛管理。需要采取教育和组织策略来解决该人群中观察到的疼痛管理不足问题。此外，在疾病过程中增加对非癌症疼痛的关注并更早地将患者转诊接受姑息性放疗可能会改善疼痛反应和治疗效果。
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