{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:57:19Z","timestamp":1781125039993,"version":"3.54.1"},"reference-count":35,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To evaluate pain syndrome characteristics, analgesic effectiveness, opioid-related adverse events, and predictors of therapy escalation in incurable patients with GI malignancies in a resource-limited, conflict-affected setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis of medical records of 80 incurable patients with GI tumors (colon 33.8%, pancreas 23.8%, stomach 22.5%, rectum 12.5%, liver\/biliary 7.5%) treated at the Palliative Care Department of the Kyiv City Clinical Oncology Center during the period of the Russian military invasion of Ukraine (2022-2024) was performed. Pain intensity was assessed using the Verbal Rating Scale (VRS). The analgesic therapy structure, escalation needs, transition trajectories, and opioid-related adverse events were analyzed. None of the patients received concurrent oncologic treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The highest pain intensity was observed in pancreatic cancer (VRS 2.68 \u00b1 0.82), where 83.3% of patients required opioid therapy from the first day of hospitalization. Therapy escalation was needed in 23.8% of patients, most frequently with initial tramadol therapy (42.3%). Parenteral morphine demonstrated the highest effectiveness (0% escalation rate). Among nonpancreatic localizations, rectal cancer showed the highest escalation rate (40.0%) despite the lowest initial pain intensity, potentially indicating underestimated neuropathic components. Among 57 opioid-treated patients, constipation occurred in 87.7%, sedation in 43.9%, and nausea in 21.1%; all adverse events were managed with locally available medications, and no patient required opioid discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Tumor localization determines pain intensity and analgesic strategy. Parenteral morphine provides superior pain control, and opioid-related adverse events can be effectively managed with affordable, locally available medications. These institutional observations suggest that effective opioid-based analgesia is feasible in conflict-affected, resource-constrained settings and may inform pain management approaches in other environments with disrupted health care infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-26-00015","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T19:59:15Z","timestamp":1781121555000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Pain Syndrome Characteristics and Analgesic Therapy Optimization in Incurable Patients With GI Malignancies"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1568-8042","authenticated-orcid":true,"given":"Anna","family":"Konysheva","sequence":"first","affiliation":[{"name":"Department of Palliative Care, Communal Non-Commercial Enterprise \u00abKyiv City Clinical Oncology Center\u00bb, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislav","family":"Myasoyedov","sequence":"additional","affiliation":[{"name":"Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.12.340"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15030591"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21453"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.5603\/PMPI.2022.0004"},{"key":"e_1_3_6_6_2","unstructured":"Ministry of Health of Ukraine: Standards of medical care\u2014Chronic pain syndrome in adults and children. 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