ESTRO 2023

Session Item

Sunday

May 14

15:15 - 16:15

Stolz 2

Patient and public perspective

Chair: , Ireland;

Chair: Sairanne Wickers, United Kingdom

Session Type: Mini-Oral

Track: Interdisciplinary

Journey:

A new index for pain management shows that patients are referred too late to palliative radiotherapy

Costanza Maria Donati, Italy

Presentation Number: MO-0560

Abstract

Abstract Title:

A new index for pain management shows that patients are referred too late to palliative radiotherapy

Authors:

Costanza Maria Donati¹, Elena Nardi², Alice Zamagni¹, Giambattista Siepe³, Claudio Malizia⁴, Francesco Cellini⁵, Alessia Di Rito⁶, Maurizio Portaluri⁶, Cristina De Tommaso⁷, Anna Santacaterina⁸, Consuelo Tamburella⁸, Rossella Di Franco⁹, Salvatore Parisi¹⁰, Sabrina Cossa¹⁰, Vincenzo Fusco¹¹, Antonella Bianculli¹¹, Pierpaolo Ziccarelli¹², Luigi Ziccarelli¹², Domenico Genovesi¹³, Luciana Caravatta¹³, Francesco Deodato¹⁴, Gabriella Macchia¹⁴, Francesco Fiorica¹⁵, Giuseppe Napoli¹⁵, Milly Buwenge¹⁶, Romina Rossi¹⁷, Silvia Cammelli¹, Marco Maltoni¹⁸, Alessio Giuseppe Morganti¹

¹Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ²Medical Statistics, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; ³Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁴Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ⁵Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy; ⁶IRCCS Istituto Tumori, "Giovanni Paolo II", Bari, Italy; ⁷General Hospital, "Perrino", Brindisi, Italy; ⁸U.O. di Radioterapia, AOOR PAPARDO PIEMONTE, Messina, Italy; ⁹S.C. di Radioterapia, dell’Istituto Nazionale Tumori Pascale, Napoli, Italy; ¹⁰Radioterapia, Opera di S. Pio da Pietralcina, Opera di S. Pio da Pietralcina, San Giovanni Rotondo, Italy; ¹¹IRCCS, CROB, Rionero In Vulture, Italy; ¹²U.O. Radioterapia Oncologica, S.O. Mariano Santo, Cosenza, Italy; ¹³Radioterapia, Università degli Studi G. D’Annunzio, Chieti, Italy; ¹⁴Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy; ¹⁵U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, Verona, Italy; ¹⁶Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; ¹⁷IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy; ¹⁸Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy

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Purpose or Objective

In the ARISE multicenter prospective observational study we evaluated the adequacy of pain management during radiotherapy (RT) using the Pain Management Index (PMI). However, the PMI has several limitations. In particular, in patients with severe pain despite the use of strong opioid drugs, the PMI is 0, improperly indicating the adequacy of therapy. Therefore we introduced a new index (MIAMI: ModifIed pAin Management Index) aimed at overcoming this PMI limitation. Moreover, we used the MIAMI to evaluate the adequacy and efficacy of analgesics prescribed to patients referred to RT.

Material and Methods

Patients, tumors, drug therapy, and pain characteristics were collected during the first visit in RT departments. A Pain Score was defined with values between 0 (no pain; NRS: 0) and 3 (severe pain; NRS: 7-10). An Analgesic Score was defined with values between 0 (no pain medication) and 3 (use of strong opioids). The PMI was calculated by subtracting the pain score from the analgesic score. All patients with PMI<0 or patients with PMI≥0 but with pain score>1 (NRS>4) were considered to have a negative MIAMI score (MIAMI-). On the contrary, all patients with PMI≥0 and pain score<2 (NRS≤4) were considered to have a positive MIAMI score (MIAMI+). Practically, if the PMI<0 includes only patients with inadequate analgesic therapy, the MIAMI includes both patients for whom analgesic therapy is inadequate and those for whom it is ineffective.

Results

One thousand forty-two patients were included. Seven-two percent of them complained of pain and were taking analgesic drugs. Patients were referred to curative and palliative RT in 48.7% and 51.2% of cases, respectively. Patients undergoing curative RT showed PMI<0 and MIAMI- in 34% and 39% of cases, respectively, while in palliative RT the rates of PMI<0 and MIAMI- were 28% and 66%, respectively (Figure 1).

Conclusion

From our analysis the following conclusions can be drawn: (i) the higher rate of inadequate pain therapy in patients candidates for curative RT shows the lack of attention to this symptom in patients in better clinical condition; (ii) the very high rate of patients candidates for palliative RT with inadequate or ineffective pain therapy suggests that patients are referred to this treatment too late, when pain can no longer be controlled with drugs, but when also the likelihood of achieving symptom relief with RT is clearly lower.