<p>Real-life management of patients with breakthrough cancer pain caused by bone metastases in Spain</p>

Abstract

Purpose: We aimed to explore the characteristics, and real-life therapeutic management of patients with breakthrough cancer pain (BTcP) caused by bone metastases in Spain, and to evaluate physicians’ opinion of and satisfaction with prescribed BTcP therapy. Participants and methods: For the purposes of this study, an ad-hoc questionnaire was developed consisting of two domains: a) organizational aspects and care standards; b) clinical and treatment variables of bone metastatic BTcP patients. In addition, physicians’ satisfaction with their prescribed BTcP therapy was assessed. Specialists collected data from up to five patients receiving treatment for BTcP caused by bone metastasis, all patients gave their consent to participate prior to inclusion. Results: A total of 103 cancer pain specialists (radiation oncologists [38.8%], pain specialists [33.0%], and palliative care (PC) specialists [21.4%]) were polled, and data on 386 BTcP patients with bone metastatic disease were collected. Only 33% of the specialists had implemented specific protocols for BTcP management, and 19.4% had established referral protocols for this group of patients. Half of all participants (50.5%) address quality of life and quality of care in their patients; however, only 27.0% did so from the patient’s perspective, as they should do. Most patients had multiple metastases and were prescribed rapid-onset fentanyl preparations (71.2%), followed by immediate-release morphine (9.3%) for the treatment of BTcP. Rapid-onset fentanyl was prescribed more often in PC units (79.0%) than in pain units (75.9%) and radiation oncology units (61.1%) ( p <0.01). Furthermore, most physicians (71.8%) were satisfied with the BTcP therapy prescribed. Conclusions: Our results demonstrate the need for routine assessment of quality of life in patients with bone BTcP. These findings also underscore the necessity for a multidisciplinary therapeutic strategy for breakthrough pain in clinical practice in Spain.

Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs

“…In our analysis, a significant association ( p < 0.10) was found between the presence of bone metastases and BTcP. This finding confirms our expectations because bone secondaries represent the main cause of predictable BTcP [ 25 , 36 ]. Moreover, the analysis showed that spontaneous (or non-predictable) BTcP is also related to metastasis.…”

Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits

“…More than 50% of patients reported unpredictable BTcP and 44.3% experienced predictable BTcP episodes. In this study, 43 a ROO was the treatment of choice for bone metastatic BTcP. In the palliative care setting, the overall percentage of sublingual fentanyl prescriptions was higher.…”

“…There is evidence that QOL is rarely included as a treatment outcome for BTcP in patients with metastases. Ferrer Albiach et al 43 enrolled 386 patients with bone metastases and BTcP in any care setting in Spain. More than 50% of patients reported unpredictable BTcP and 44.3% experienced predictable BTcP episodes.…”

High-rate breakthrough cancer pain and tumour characteristics – literature review and case series

“…64 Many breakthrough pain episodes of greater intensity in the advanced stages of cancer are due to bone pain caused by metastasis 17 and require additional proper therapy. Albiach et al 76 collected data from patients with metastatic bone disease and BTcP and demonstrated that primary cancer was mainly localized in the lungs and prostate (85 out of 386 patients or 22%), and BTcP occurred spontaneously and suddenly with high pain intensity in 70.6% of cases.…”