Breakthrough Cancer Pain: An Observational Study of 1000 European Oncology Patients

Davies, Andrew; Buchanan, Alison; Zeppetella, Giovambattista; Porta-Sales, Josep; Likar, Rudolf; Weismayr, Wolfgang; Sláma, Ondřej; Korhonen, Tarja; Filbet, Marilène; Poulain, P.; Mystakidou, Kyriaki; Ardavanis, Alexandros; O’Brien, Tony; Wilkinson, P; Caraceni, Augusto; Zucco, F; Zuurmond, W. W. A.; Andersen, Steen; Damkier, Anette; Vejlgaard, Tove Bahn; Nauck, Friedemann; Radbruch, Lukas; Sjölund, Karl-Fredrik; Stenberg, Mariann

doi:10.1016/j.jpainsymman.2012.12.009

Cited by 175 publications

(178 citation statements)

References 13 publications

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“…1,26 More recently, it has been underlined that background pain should be of mild intensity. 3 Many transmucosal fentanyl products have been licensed for BTP in opioid-tolerant patients. 21 These preparations, named rapid-onset opioids (ROOs), have some advantages such as ease of administration, rapid onset of action, and avoidance of first-pass metabolism, which consequently offer an interesting alternative to intravenous, subcutaneous, oral, and rectal administration in the management of BTP.…”

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confidence: 99%

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Mercadante

Prestia

Adile

et al. 2014

The Journal of Pain

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The aim of this randomized, crossover, comparison study was to assess the analgesic and adverse effects of 2 nasal preparations, intranasal fentanyl (INFS) and fentanyl pectin nasal spray (FPNS), for breakthrough pain, given in doses proportional to opioid basal regimen. Each patient randomly received INFS or FPNS in doses proportional to opioid dosages used for background analgesia for 2 pairs of episodes. For each episode of breakthrough pain, pain intensity and adverse effects intensity were recorded just before starting the INFS or FPNS (T0) and 5 minutes (T5), 10 minutes (T10), and 20 minutes (T20) after the administration of the nasal drugs. Sixty-nine patients were studied. The mean age was 63.4 years, and 37 patients were males. For the present analysis, 188 episodes were considered. A statistical decrease in pain intensity was observed with both nasal drugs after 5, 10, and 20 minutes. A decrease in pain intensity of >33% was observed in 16, 102, and 159 treated episodes at T5, T10, and T20, respectively. Adverse effects were of mild nature in most cases or were preexistent because of basal opioid therapy. No differences were found in summed pain intensity difference 20 minutes after dosing. Most of patients did not find substantial preferences. INFS and FPNS were effective and well-tolerated treatments for breakthrough pain management. Both delivery systems, in doses proportional to the basal opioid regimen, provided significant analgesia within 10 minutes, without producing relevant adverse effects.Perspective: This article showed that INFS and FPNS in doses proportional to basal opioid regimen are equally safe and effective for the management of breakthrough pain in cancer patients. These data provide new insights on the use of nasal preparations of fentanyl.

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mentioning

confidence: 99%

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Mercadante

Prestia

Adile

et al. 2014

The Journal of Pain

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“…For a similar temporal phenomenon, breakthrough pain, most episodes last less than one hour. 14,15 Duration and intensity are the most particular characteristics that may help in providing a clear distinction with normal oscillations in symptom intensity during the day. This also has a relevant meaning in terms of therapeutic interventions.…”

Section: Duration and Intensitymentioning

confidence: 99%

“…Breakthrough pain is an exacerbation of pain intensity on a well-controlled background pain, generally treated by opioids. 14,15 However, different from background pain intensity, it is quite difficult to define an ''acceptable'' background breathlessness. Unlike chronic pain, breathlessness poses therapeutic challenges, as drugs commonly used have an indirect effect and there are no specific first-choice treatments.…”

Section: Treatment Of Breathlessness and Episodic Breathlessnessmentioning

confidence: 99%

Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Mercadante

Aielli

Adile

et al. 2016

Journal of Pain and Symptom Management

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CONTEXT:Episodic breathlessness is a relevant aspect in patients with advanced cancer.\ud OBJECTIVES:The aim of this study was to assess the different aspects of this clinical phenomenon.\ud METHODS:A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated.\ud RESULTS:Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness.\ud CONCLUSION:This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures

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“…Another study identified the nursing diagnoses and interventions related to pain in cancer patients [23]. Many studies have assessed the intensity of pain and its interference in daily activities, the number of episodes, used therapeutic approaches and the effectiveness of these approaches [25][26][27][28][29]. It was also observed, as compared to the use of morphine as first choice for analgesia relative to the group following the analgesic scale (starting treatment with nonopioid, followed by weak opioid and finally potent opioid) [26].…”

Section: Clinical Practice (N = 7)mentioning

confidence: 99%

Evidence For The Cancer Patients’ Pain Management: An Integrative Review

et al. 2016

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Background: On cancer, pain is one of the most frequent and distressing symptoms, being present in all stages of the disease. Knowing that, this study aimed to analyze the available evidence in the literature about chronic pain management by nurses in adult patients with cancer. Methods and Results:It is an integrative review searched in the PUBMED, LILACS, CINAHL and COCHRANE databases. Nineteen studies met the inclusion criteria proposed in the study, most controlled clinical trials. The articles were analyzed and grouped into three thematic categories: health education (52.6%), clinical practice (36.9%) and complementary therapies (10.5%). Conclusion:The nurse has various means for better pain management, promoting effective assistance, minimizing possible barriers, promoting the autonomy of the patient and the ability to self-control, resulting in greater patient satisfaction.

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Breakthrough Cancer Pain: An Observational Study of 1000 European Oncology Patients

Abstract: Breakthrough cancer pain is an extremely heterogeneous condition.

Cited by 175 publications

References 13 publications

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study

Evidence For The Cancer Patients’ Pain Management: An Integrative Review

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