{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:16:18Z","timestamp":1791584178941,"version":"4.3.4"},"reference-count":57,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RC-2025-2795987 Project"],"award-info":[{"award-number":["RC-2025-2795987 Project"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Previous studies have often reported a link between advanced age and inadequate cancer pain management. Given Italy\u2019s demographic profile as the country with the oldest population in Europe, it offers an ideal setting to explore whether this association remains valid today. Aim: This study aimed primarily to assess the influence of advanced age on the adequacy of pain management among patients receiving treatment in Italian radiotherapy (RT) departments, and secondarily, to identify age-specific determinants of analgesic undertreatment. Methods: In this prospective, multicenter study, we enrolled 2104 consecutive patients attending 13 RT centers between October and November 2019. Pain intensity was evaluated using the numeric rating scale (NRS), and patients reporting scores \u2265 1 (n = 1353) were included in the analysis. Pain management adequacy was assessed using the Pain Management Index (PMI), with negative values indicating undertreatment. A two-step statistical approach was employed: variable selection via Least Absolute Shrinkage and Selection Operator regression, followed by Classification and Regression Tree analysis to identify key predictors. Separate analyses were performed for the overall population, older adults (\u226565 years), and younger adults (18\u201364 years). Results: Overall, 42% of patients were undertreated (PMI &lt; 0), without significant differences between older (41.0%) and younger patients (43.1%). However, factors contributing to undertreatment varied according to age. For the entire cohort, non-cancer pain was associated with substantially higher rates of undertreatment (74.3%) compared to cancer-related pain (34.2%). Among cancer patients, those receiving curative RT had poorer pain control (49.4%) than those receiving palliative RT (28.8%). In older patients, geographic location strongly influenced pain management, with higher rates of undertreatment in central and southern Italy compared to the north (e.g., palliative RT: 64.0% vs. 15.4%, respectively). Conversely, younger patients showed no geographical differences; instead, timing of assessment (beginning vs. end of RT) influenced outcomes, with improved PMI values towards the end of treatment. Conclusions: Unlike previous studies, advanced age itself was not associated with inadequate analgesia. However, the determinants of inadequate pain management differed significantly by age: geographic disparities were predominant among older patients, while assessment timing influenced outcomes for younger patients. Further longitudinal research and targeted interventions are needed to address these age-dependent challenges.<\/jats:p>","DOI":"10.3390\/cancers17183073","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T16:53:42Z","timestamp":1758300822000},"page":"3073","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Older Age Does Not Predict Inadequate Pain Management in Cancer Patients: A Multicenter Prospective Analysis from Italian Radiotherapy Departments (ARISE-Study)"],"prefix":"10.3390","volume":"17","author":[{"given":"Costanza M.","family":"Donati","sequence":"first","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Galietta","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2145-2300","authenticated-orcid":false,"given":"Francesco","family":"Cellini","sequence":"additional","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"},{"name":"Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9966-6342","authenticated-orcid":false,"given":"Arina A.","family":"Zamfir","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Di Rito","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, IRCCS Istituto Tumori \u2018Giovanni Paolo II\u2019 Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Portaluri","sequence":"additional","affiliation":[{"name":"ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Santacaterina","sequence":"additional","affiliation":[{"name":"U.O. di Radioterapia AOOR Papardo Piemonte, 98121 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Mammini","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6918-2178","authenticated-orcid":false,"given":"Rossella","family":"Di Franco","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Parisi","sequence":"additional","affiliation":[{"name":"Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0643-5684","authenticated-orcid":false,"given":"Antonella","family":"Bianculli","sequence":"additional","affiliation":[{"name":"Medical Physics Department, IRCCS-CROB\u2014Centro di Riferimento Oncologico della Basilicata, 85028 Potenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Ziccarelli","sequence":"additional","affiliation":[{"name":"U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Ziccarelli","sequence":"additional","affiliation":[{"name":"U.O. Radioterapia Oncologica, S.O. Mariano Santo, 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Genovesi","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, SS Annunziata Hospital, G. D\u2019Annunzio University of Chieti-Pescara, 66100 Chieti, Italy"},{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \u201cG. D\u2019Annunzio\u201d University of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Caravatta","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, \u201cC. e G. Mazzoni\u201d Hospital, 63100 Ascoli Piceno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1276-5070","authenticated-orcid":false,"given":"Francesco","family":"Deodato","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, Responsible Research Hospital, 86100 Campobasso, Italy"},{"name":"Istituto di Radiologia, Universit\u00e0 Cattolica S. Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0529-201X","authenticated-orcid":false,"given":"Gabriella","family":"Macchia","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, Responsible Research Hospital, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9404-3655","authenticated-orcid":false,"given":"Francesco","family":"Fiorica","sequence":"additional","affiliation":[{"name":"U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2111-0164","authenticated-orcid":false,"given":"Silvia","family":"Cammelli","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milly","family":"Buwenge","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Angelini","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 orl\u00ec-Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco C.","family":"Maltoni","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-6665","authenticated-orcid":false,"given":"Nam P.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Howard University, Washington, DC 20060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9793-3410","authenticated-orcid":false,"given":"Alessio G.","family":"Morganti","sequence":"additional","affiliation":[{"name":"Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6711-350X","authenticated-orcid":false,"given":"Savino","family":"Cilla","sequence":"additional","affiliation":[{"name":"Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1093\/jnci\/djg014","article-title":"National Institutes of Health State-of-the Science Conference statement: Symptom Management in Cancer: Pain, Depression, and Fatigue","volume":"95","author":"Patrick","year":"2003","journal-title":"J. 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