Assessing Gender Differences for Non-Predictable Breakthrough Cancer Pain Phenomenon: A Secondary Analysis from IOPS-MS Study

Sabrina Bimonte; Piergiacomo Di Gennaro; Anna Crispo; Sergio Coluccia; Assunta Luongo; Alfonso Amore; Egidio Celentano; Francesco Del Prato; Daniela Schiavo; Davide Nocerino; Marco Cascella; Arturo Cuomo

doi:10.2147/JPR.S445222

Assessing Gender Differences for Non-Predictable Breakthrough Cancer Pain Phenomenon: A Secondary Analysis from IOPS-MS Study

J Pain Res. 2024 Sep 5:17:2861-2871. doi: 10.2147/JPR.S445222. eCollection 2024.

Authors

Affiliations

¹ Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
² Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
³ Melanoma and Sarcoma Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
⁴ PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
⁵ Department of Medicine, University of Salerno, Salerno, Italy.

^# Contributed equally.

Abstract

Purpose: Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) subtype occurs in the absence of any specific activity. Evidence showed that gender differences exist in pain response sensitivity and clinical pain risk. This analysis aimed to signify the gender differences for the NP-BTcP phenomenon.

Patients and methods: This is a secondary analysis of the Italian Oncologic Pain multiSetting-Multicentric Survey (IOPS-MS), the largest study on BTcP. The subset of NP-BTcP cases for non-gender-specific cancer was considered. Univariable and multivariate analyses were conducted to identify gender differences for the NP-BTcP profile about its intensity, number of episodes per day, and type. A metastatic status-stratified analysis was performed to compare gender with the main clinical variables among the population with NP-BTcP.

Results: Males exhibited a higher occurrence of BTcP in the thorax region compared to females (15% vs 11%, respectively, p = 0.03). Males also had a higher onset of BTcP, a higher BTcP therapy dosage (33% vs 28%, p = 0.04, mean: 201 vs 186, p = 0.02) and a lower Karnofsky score (mean: 46.9 vs 49.2, p = 0.03) compared to females. Similar gender differences were found for metastatic patients in the BTcP site (14% vs 8.5%, respectively; p = 0.01), peak onset (33% vs 27%, p = 0.02), BTcP therapy dosage (199 vs 185, p=0.04), and Karnofsky score (mean 47.5 vs 50.4, p = 0.009). Phenotype 2 was more characterized by non-metastatic males (41% vs 23%, p = 0.020) while non-metastatic females presence was predominant among others.

Conclusion: In this study, gender differences according to site, onset and dosage of BTcP were found. The phenotype characterization of BTcP needs to be further investigated for a possible useful function in the management of cancer-related pain in non-metastatic patients.

Keywords: cluster analysis; gender cancer pain; non-predictable breakthrough cancer pain.

Grants and funding

The original study was sponsored by Molteni Farmaceutici, Italy. Data were independently analyzed and managed by authors. The funders had no role in the design of these secondary analyses or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.