Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study

Abstract

IntroductionThere is no unanimous consensus on the clinical features to define breakthrough cancer pain (BTcP). The current project aimed to investigate the opinion of a panel of experts on cancer pain on how to define, diagnose, assess, treat and monitor BTcP.Materials and methodsA two-round Spanish multi-centre exploratory Delphi study was conducted with medical experts (n = 90) previously selected from Medical Oncology Services, Radiation Oncology, Palliative Care/Home Care Teams, and Pain Units. The study intended to seek experts’ consensus and to define a set of recommendations for the management of BTcP.ResultsIt was generally agreed that, definition of BTcP implies that baseline pain should be controlled (84 %), although not necessarily with opioids (only 30 %); there must be exacerbations (98.9 %); the duration of each episode should last <1 h (70 %); the intensity of pain ≥7 out of 10 (67.8 %); and the number of flares per day should not be less than four. All participants supported the use of the Davies algorithm for the diagnosis. The use of a ‘Patient Diary’ was highly recommended. The optimal treatment should have a rapid onset, a short-acting analgesic effect (1–2 h) and transmucosal nasal or oral administration. It was considered very important to develop protocols for the management of cancer pain.ConclusionsThe present Delphi study identified a set of recommendations to define, assess and monitor BTcP.

Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care2016;6:344–52)’

“…Nevertheless, most contemporary guidelines exclude end-of-dose pain/end-of-dose failure as a subtype of breakthrough pain, since this phenomenon represents a ‘failure’ of the around-the-clock/background medication 5–8. Moreover, there appears to be high agreement with this position among relevant healthcare professionals within Europe 9 10. In this study, 28% patients with breakthrough pain identified that ‘scheduled pain medication wearing off’ was a precipitant of their breakthrough cancer pain, which again suggests that many of these patients did not have adequately controlled background pain.…”

Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain (Preprint)

“…The experience in the management of patients with BTcP was shown to be >12 ± 7 years, with an average of > 400 patients attended during the last year. 36 (20.5%) out of the physicians recruited for the present study had also participated in the previous Delphi consensus study [8], and most of the sample (88.9%) was aware of the recommendations and (85.5%) considered them to be useful for their clinical daily practice. Table 1 shows the digital profile of the sample.…”

“…The idea was then creating a mobile application able to run in as a native app on various mobile platforms and operating systems (such as Android, iOS). App INES·DIO contents gathered the most significant results of a Spanish Delphi study about the consensus and controversies in the definition, assessment, treatment and monitoring of BTcP [8]. This application allows the physician to generate an individual patient register to be finally included (via email) in the clinical history.…”

“…Most sample recruited was aware about the consensus and controversies driven by the original Delphi study [8] that set the ground for the development of App INES·DIO and the subsequent usability testing described along this study. Moreover, conclusions reported by the Delphi study were perceived to have a positive impact on clinical daily practice on attendance of BTcP patients.…”

“…Recently, Boceta et al published the results of a two-round Spanish multicenter exploratory Delphi study which investigated the opinion of an expert panel in cancer pain to conclude how to define, diagnose, assess, treat and monitor BTcP [8]. This study was intended to seek consensus in the definition of BTcP and identify the controversies regarding a set of recommendations for the complete management of BTcP in clinical practice.…”