Impact of setting of care on pain management in patients with cancer: a multicentre cross-sectional study.
BACKGROUND
No study has so far addressed whether differences do exist in the management of cancer-related pain in patients admitted to oncology and non-oncology settings.


METHODS
A multicentre cross-sectional study in 48 Italian hospitals has enrolled 819 patients receiving analgesic therapy for cancer-related pain. Demographics and clinical and analgesic therapy information have been prospectively collected by standardized forms. Adequacy of pain management has been evaluated by the Pain Management Index (PMI).


RESULTS
Differences in the analgesic drug administration according to settings of care have been evident, non-opioids more frequently being administered in non-oncology units (19.6% versus 7.0%; P < 0.0001), while strong opioids are more frequently used in the oncology units (69.5% versus 51.9%; P < 0.0001). The number of patients receiving inadequate therapy (PMI < 0) has lowered in oncology compared with non-oncology units (11.3% versus 18.8%; P = 0.0024). Results of multiple logistic regression analysis have shown that the admission to non-oncology setting [odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.15-2.67; P = 0.0096] and the absence of metastatic disease (OR = 1.60, 95% CI = 1.04-2.44; P = 0.0317) were independent factors associated with an increased risk of receiving an inadequate analgesic therapy.


CONCLUSIONS
Oncology wards provide the most adequate standard of analgesic therapy for cancer-related pain.
Sichetti
D
D
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti).
Bandieri
E
E
Palliative Care Unit, Ausl Modena, Modena.
Romero
M
M
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti).
Di Biagio
K
K
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti).
Luppi
M
M
Department of Oncology, Haematology and Respiratory Diseases, Azienda Ospedaliera Universitaria, University of Modena and Reggio Emilia, Modena. Electronic address: mario.luppi@unimore.it.
Belfiglio
M
M
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti).
Tognoni
G
G
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti).
Ripamonti
C I
CI
Supportive Care in Cancer Unit, IRCCS Foundation, National Cancer Institute, Milano, Italy.
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011379:Prognosis
D000700:Analgesics