Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Abstract

IntroductionAn ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.MethodsThirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.ResultsBackground pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.ConclusionsThese preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.FundingMolteni Farmaceutici, Italy.

Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients

“…The mean duration of untreated BTP episodes was similar to that described in previous surveys, reporting a variable duration of 30–60 min [ 10 , 11 , 15 , 16 , 19 , 20 , 21 , 22 ]. Indeed, duration of untreated episodes is based on patients’ recalling and difficult to be properly assessed by patients.…”

“…Some factors were independently associated with the duration of BTP. A longer duration of BTP episodes was found in hospice and home care patients, as well as in older patients, in previous studies, patients who had a low background pain intensity, or who were admitted to hospice or were seen at home, had a longer BTP duration [ 11 , 15 ]. Of interest, predictable BTP was less likely to be associated with a longer BTP duration.…”

“…The percentage of patients with predictable BTP was consistent with previous epidemiological studies [ 11 , 16 ]. In a previous analysis, with a limited number of patients, predictable BTP was more likely observed in certain disease-related conditions (primary tumor, setting, anticancer treatments) and in patients with lower background pain and BTP intensities [ 15 ]. Patients with bone metastases, who are more often observed in radiotherapy setting, may have lower pain levels at rest.…”

“…In multicenter European surveys [ 10 , 11 , 16 ], time to maximum BTP intensity onset was 10–15 min, but no further analyses were conducted to identify risk factors. In a preliminary analysis of a limited number of patients, a fast-onset BTP was associated with serious mucositis or radiotherapy setting [ 15 ]. This can be explained by the immediate pain input by a damaged mucosa, for example on swallowing.…”

“…The aim of this study was to assess the main characteristics of BTP to find potential factors influencing its presentation in a large number of patients [ 15 ].…”