Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Mario Spatafora, Francesco Carrozza, Massimo Di Maio, Francesco Ferraù, Brancaccio, Francesco Rosetti, Sergio Federico Robbiati, Isa, Mario Spatafora, Giovanni Pietro Ianniello, Di Salvo, Luciano Frontini, Iaffaioli, Vincenzo Adamo, Elena Piazza, Luigi Manzione, Santi Barbera, Francesco Perrone, Cesare Gridelli, Ciro GalloAlessandra Bearz, Elena Piazza

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Pain is a highly distressing symptom for patients with advanced cancer. WHOanalgesic ladder is widely accepted as a guideline for its treatment. Our aim wasto describe pain prevalence among patients diagnosed with advanced non-small-celllung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of painmanagement. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded.Adequacy of pain management was evaluated by the Pain Management Index (PMI).Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe);50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3%very much). Bone metastases strongly affected presence of pain. Mean global QoLlinearly decreased from 64.9 to 36.4 from patients without pain to those withsevere pain (P<0.001). According to PMI, 616 out of 752 patients reporting pain(82%) received inadequate analgesic treatment. Bone metastases were associatedwith improved adequacy and worst pain with reduced adequacy at multivariateanalysis. In conclusion, pain is common in patients with advanced NSCLC,significantly affects QoL, and is frequently undertreated. We recommend that:(i). pain self-assessment should be part of oncological clinical practice; (ii). pain control should be a primary goal in clinical practice and in clinicaltrials; (iii). physicians should receive more training in pain management; (iv). analgesic treatment deserves greater attention in protocols of anticancertreatment.
Original languageEnglish
Pages (from-to)2288-2296
Number of pages9
JournalBritish Journal of Cancer
Publication statusPublished - 2004


All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Spatafora, M., Carrozza, F., Di Maio, M., Ferraù, F., Brancaccio, Rosetti, F., Robbiati, S. F., Isa, Spatafora, M., Ianniello, G. P., Di Salvo, Frontini, L., Iaffaioli, Adamo, V., Piazza, E., Manzione, L., Barbera, S., Perrone, F., Gridelli, C., ... Piazza, E. (2004). Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer. British Journal of Cancer, 90, 2288-2296.