Exploring the relationship between cancer type and non-cancer pain management (ARISE-1 study)

This investigation sought to elucidate the suboptimal management of non-cancer-related pain in oncology patients, with a focus on those receiving radiotherapy. The study aimed to identify factors that could predict the effectiveness of pain management in this demographic. A detailed examination of a subset of participants from the ARISE study was undertaken, targeting those reporting non-malignant pain. A standardized pain taxonomy was applied to classify each patient’s pain as tumor-related, treatment-related, non-cancer, or mixed pain. The non-cancer pain was definited as pain etiologically unrelated to cancer or its treatments, with an independent underlying cause. We collected comprehensive demographic and clinical data, alongside pain intensity ratings. The pain management index (PMI) was utilized to evaluate the adequacy of pain management. Advanced computational analyses, including least absolute shrinkage and selection operator algorithm and the classification and regression tree analysis, were employed to establish a predictive model for pain management outcomes. The cohort included 446 individuals reporting non-cancer pain. According to the pain management index, 73.1% of patients were classified as receiving inadequate pain management. Breast cancer : 83.8% of breast cancer patients experienced suboptimal pain management. Geographically, northern Italy had a lower incidence of inadequate pain management (67.7%) compared to southern and central regions (86.6%). Age differences in breast cancer : among patients from southern and central regions, younger partecipants (< 50 years) reported a higher prevalence of poorly managed pain (92.9%) compared to older patients (85.4%). Non-breast cancer types : Overall : 63.6% of patients with non-breast cancers experienced inadequate pain management. Gastrointestinal cancer : Patients reported better pain management outcomes (PMI < 0: 62.5%) relative to other non-breast cancer diagnoses (PMI < 0: 66.5%). Head and neck tumors : These patients had a more favorable pain management outcome (PMI < 0: 59.6%) compared to others with non-breast and non-gastrointestinal cancers (PMI < 0: 68.5%). In this cohort, inadequate management of non-cancer pain was common, with notable variations across tumour types, age groups and geographical areas. Tumour type emerged as a predictive factor associated with inadequate pain management within our model, suggesting that differences across cancer types may influence how non-neoplastic pain is assessed and treated in oncology settings. However, this association should be interpreted with caution. Further studies using rigorous pain taxonomies and validated measures of analgesic adequacy are needed to clarify whether these patterns reflect tumour-related characteristics, misclassification of treatment-related pain, or variations in clinical practice. A deeper understanding of these factors may support the development of more tailored and effective approaches to pain management in oncological care.