ESTRO 2023

Session Item

Saturday

May 13

09:00 - 10:00

Business Suite 1-2

Palliative radiotherapy & SBRT

Chair: Nicolaus Andratschke, Switzerland

Session Type: Poster Discussion

Track: Clinical

Journey:

Reluctance to escalate drug therapy in cancer patients increases with the class of analgesics

Costanza Maria Donati, Italy

Presentation Number: PD-0072

Abstract

Abstract Title:

Reluctance to escalate drug therapy in cancer patients increases with the class of analgesics

Authors:

Costanza Maria Donati¹, Elena Nardi², Alice Zamagni¹, Giambattista Siepe³, Francesco Cellini⁴, Alessia Di Rito⁵, Maurizio Portaluri⁶, Cristina De Tommaso⁷, Anna Santacaterina⁸, Consuelo Tamburella⁸, Rossella Di Franco⁹, Salvatore Parisi¹⁰, Sabrina Cossa¹⁰, Vincesco 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; ⁴Fondazione 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; ⁵IRCCS Istituto Tumori, "Giovanni Paolo II", , Bari, 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, Casa Sollievo della Sofferenza, 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

Pain is one of the most common symptoms among cancer patients, occurring in 30-50% of patients undergoing active antineoplastic therapy and in 75-90% of patients with advanced stage tumor. Furthermore, studies on pain assessment during radiotherapy (RT) are lacking. The aim of this multicenter observational prospective trial was to evaluate the prevalence of pain in RT departments using the Numeric Rating Score (NRS). Moreover, we analyzed the correlation between pain intensity and classes of used analgesic drugs.

Material and Methods

In this study we enrolled 2104 patients from 13 RT Departments. RT aims and patients and pain characteristics were recorded, using a data collection sheet, during patients visits (in the course or at the end of treatment). The Pain Score was graded from 0 (no pain; NRS: 0) to 3 (severe pain; NRS: 7-10). An Analgesic Score was defined with values between 0 (no pain medication) and 3 (use of strong opioids). This study was approved by the Ethical Committee of the participating centers (ARISE-1 study).

Results

Of enrolled patients, 1417 had pain or were under analgesic treatment. Among them, 53.8% complained of intermediate to severe pain. The incidence of intermediate/severe pain was found to increase progressively from patients not taking analgesic drugs, to those taking non-opioid drugs, to those taking weak opioid drugs, showing a clearly lower willingness to prescribe drugs of a higher class as the same increased (30%, 46%, and 83%, respectively; p<0.001; Figure 1). Moreover, patients under strong opioids reported moderate/severe pain in 75% of cases.

Conclusion

This analysis shows persistent barriers to the use of strong opioid even in cancer patients. Furthermore, our study shows the high incidence of moderate to severe pain in patients receiving opioid drugs. The frequent ineffectiveness of opioid therapy in this setting, probably, at least in part, due to suboptimal doses or posology. Therefore, further efforts are needed to improve pain management, particularly in the RT settings. In particular, both training in pain therapy for radiation oncologists and closer multidisciplinary collaboration are needed for this purpose.