ESTRO 2023

Session Item

Saturday

May 13

15:15 - 16:15

Business Suite 1-2

Breast

Chair: , Poland

Session Code: 1440

Session Type: Poster Discussion

Track: Clinical

Why is pain poorly managed in breast cancer patients? A multicenter analysis on 2104 patients

Costanza Maria Donati, Italy

Presentation Number: PD-0239

Abstract

Abstract Title:

Why is pain poorly managed in breast cancer patients? A multicenter analysis on 2104 patients

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, 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

Treatment of pain is frequently inadequate in cancer patients, especially in subjects with non-neoplastic pain (versus neoplastic) and undergoing curative treatment (versus palliative). Moreover, several studies based on the Pain Management Index (PMI) showed that also breast cancer (BCa) is correlated with pain under-treatment. Aim of this analysis is to evaluate whether the poor pain management in BCa patients is due to the non-neoplastic origin of pain (from surgical scar) and to the adjuvant purpose of therapy in most subjects and/or to the female gender.

Material and Methods

Data on gender, age, ECOG Performance Status, RT aim, primary tumor, tumor stage, intensity of pain measured with the Numeric Rating Scale (NRS), type of pain (cancer pain [CP], non-cancer pain [NCP], mixed pain [MP]) were collected. 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. A negative PMI value indicates an inadequate analgesic prescription. This study was approved by the Ethical Committee of the participating centers (ARISE-1 study).

Results

The results of our study are shown in Table 1. The analysis confirmed the lower adequacy of pain management in BCa patients, with statistically significant differences in both subjects with CP and NCP. However, the incidence of PMI<0 was significantly higher only in BCa patients undergoing curative therapy and not in those treated with palliative radiotherapy. Finally, the incidence of PMI<0 was more than double, in patients with BCa, compared to patients with other female cancers (cervix, endometrium) with a trend towards statistical significance.

Conclusion

Inadequate pain management in BCa is largely, but not only, due to the curative intent of therapy in the majority of patients and particularly to the very high rate (81.1%) of patients with PMI<0 within subjects with NCP. Instead, belonging to the female gender does not represent in itself a cause of inadequate pain management.