First EFIC® Symposium Societal Impact of Pain - SIP

26
Giovanni Apolone
Giovanni Apolone, MD
Head
Lab. for the Translational & Outcome Research
Head
Center for the Evaluation & Research on Pain
Dept. of Oncology
Istituto di Ricerche Farmacologiche
„Mario Negri“
Via La Masa 19, 20156 Milan – Italy
+ 39 02 39014-515
www.marionegri.it
Background
Most patients with advanced or metastatic
cancer experience pain and despite several
guidelines, inadequate treatment is well documented
and can involve up to 43% of cases. In
Italy cancer pain management is a major problem
as opioid consumption rates are among
the lowest in Europe.
Methods
Data were obtained from a multi-center, openlabel,
prospective, non-randomized study
launched in Italy in 2006 to evaluate the epidemiology,
pattern and quality of care in cancer
patients. Data were collected using a webbased
standardized system that allowed the
collection of several patients and physicians reported
information and outcomes, mostly related
to pain and pain effects. To assess analgesic
care adequacy, we used a standardized
measure, the Pain Management Index (PMI)
that compares the most potent analgesic prescribed
for a patient with that patient’s reported
level of worst pain together with a selected
list of clinical indicators. Univariate and
multivariable methods were used to assess
the relationship between PMI and potential predictors.
Results
One hundred and ten centers recruited 1,801
valid cases. Patients had severe pain (mean
worst pain at baseline= 6.8), half had bone
metastases, episodes of breakthrough pain
and were still on active anti-cancer treatment,
59% were recruited by oncologic centers, and
most were not aware of their prognosis. Sixtyone
per cent of cases were receiving a WHOlevel
III opioid. In the whole sample 25.1% were
classified as potentially inadequately treated,
with large variations (from 9.8 to 55.3%) according
to variables describing patients, centres
and pattern of care. After adjustment with
a multivariable logistic regression model, type
of recruiting centers, receiving adjuvant therapy
or not and type of patient recruited (new
versus already on follow-up) had a significant
association with inadequate treatment (odds
ratio >1.2 and p-value