Donati Costanza M, Galietta Erika, Cellini Francesco, Zamfir Arina A, Di Rito Alessia, Portaluri Maurizio, Santacaterina Anna, Mammini Filippo, Di Franco Rossella, Parisi Salvatore, Bianculli Antonella, Ziccarelli Pierpaolo, Ziccarelli Luigi, Genovesi Domenico, Caravatta Luciana, Deodato Francesco, Macchia Gabriella, Fiorica Francesco, Cammelli Silvia, Buwenge Milly, Angelini Lucia, Rossi Romina, Maltoni Marco C, Nguyen Nam P, Morganti Alessio G, Cilla Savino
Radiation Oncology, 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.
Cancers (Basel). 2025 Sep 19;17(18):3073. doi: 10.3390/cancers17183073.
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.
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.
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 ( = 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).
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.
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.
以往研究经常报道高龄与癌症疼痛管理不足之间存在关联。鉴于意大利作为欧洲人口老龄化程度最高的国家的人口结构状况，它为探究这种关联如今是否仍然成立提供了理想的环境。
本研究主要旨在评估高龄对在意大利放疗科接受治疗的患者疼痛管理充分性的影响，其次是确定镇痛治疗不足的年龄特异性决定因素。
在这项前瞻性多中心研究中，我们纳入了2019年10月至11月期间在13个放疗中心连续就诊的2104例患者。使用数字评分量表（NRS）评估疼痛强度，报告分数≥1分（n = 1353）的患者纳入分析。使用疼痛管理指数（PMI）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：通过最小绝对收缩和选择算子回归进行变量选择，然后进行分类和回归树分析以确定关键预测因素。对总体人群、老年人（≥65岁）和年轻人（18 - 64岁）分别进行分析。
总体而言，42%的患者治疗不足（PMI < 0），老年人（41.0%）和年轻人（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。对于整个队列，与癌症相关疼痛（34.2%）相比，非癌症疼痛的治疗不足率显著更高（74.3%）。在癌症患者中，接受根治性放疗的患者疼痛控制较差（49.4%），而接受姑息性放疗的患者为（28.8%）。在老年患者中，地理位置对疼痛管理有很大影响，意大利中部和南部的治疗不足率高于北部（例如，姑息性放疗分别为64.0%和15.4%）。相反，年轻患者没有地理差异；相反，评估时间（放疗开始时与结束时）影响结果，治疗结束时PMI值有所改善。
与以往研究不同，高龄本身与镇痛不足无关。然而，疼痛管理不足的决定因素在年龄上有显著差异：地理差异在老年患者中占主导，而评估时间影响年轻患者的结果。需要进一步的纵向研究和有针对性的干预措施来应对这些与年龄相关的挑战。
