Prevalence and characterization of breakthrough pain in patients with cancer in Spain: the CARPE-DIO study

Abstract

We aimed to evaluate the prevalence, characteristics and impact of breakthrough pain (BTP) in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain using a multicenter, observational, cross-sectional, multidisciplinary study. Investigators had to record all patients seen at the clinic during 1 month, determine whether the patients had cancer pain, and apply the Davies algorithm to ascertain whether the patients were suffering from BTP. Of the 3,765 patients with cancer, 1,117 (30%) had cancer-related pain, and of these patients, 539 had BTP (48%, 95%CI:45–51). The highest prevalence was found in patients from palliative care (61%, 95%CI:54–68), and the lowest was found in those from hematology (25%, 95%CI:20–31). Prevalence varied also according to sex and type of tumor. According to the Alberta Breakthrough Pain Assessment Tool duration, timing, frequency, location, severity, quality, causes, and predictability of the BTP varied greatly among these patients. BTP was moderate (Brief Pain Inventory [BPI]-severity median score = 5.3), and pain interference was moderate (BPI-interference median score = 6.1) with a greater interference with normal work, general activity, and enjoyment of life. Patients with BTP showed a mean ± standard deviation score of 28.5 ± 8.0 and 36.9 ± 9.5 in the physical and mental component, respectively, of the SF-12 questionnaire. In conclusion, prevalence of BTP among patients exhibiting cancer-related pain is high. Clinical presentation is heterogeneous, and therefore, BTP cannot be considered as a single entity. However, uniformly BTP has an important impact on a patient’s functionality, which supports the need for early detection and treatment.

The Prevalence and Characteristics of Breakthrough Cancer Pain in Patients Receiving Low Doses of Opioids for Background Pain

“…The large variability also depended on the setting, stage of disease, background opioid analgesia, and methodology used for the diagnosis of BTP, other than the design of the studies, which was often retrospective [ 16 , 19 ]. Indeed, BTcP is differently observed in 50–90% of all hospitalized cancer patients, in 89% of patients admitted to homes and hospices, and in 35% of outpatients or in 83% of patients attending their first visit [ 23 , 24 , 25 ]. In a recent multicenter study performed in Spain using a specific diagnostic algorithm, BTcP prevalence in cancer patients was 48% [ 25 ].…”

“…Indeed, BTcP is differently observed in 50–90% of all hospitalized cancer patients, in 89% of patients admitted to homes and hospices, and in 35% of outpatients or in 83% of patients attending their first visit [ 23 , 24 , 25 ]. In a recent multicenter study performed in Spain using a specific diagnostic algorithm, BTcP prevalence in cancer patients was 48% [ 25 ]. Thus, BTcP prevalence can be different according to the way it is studied.…”

Pancreas Cancer-Associated Pain Management

“…Patients requiring several daily doses of IR opioids would benefit from extended release (ER) opioid, providing prolonged and more consistent plasma concentration of drug, thus minimizing fluctuations. IR opioid should be made available for management of breakthrough pain, on an as‐needed basis every 3 to 4 hours, at approximately 10%–20% of the basal daily dose of the scheduled ER opioid [48]. Because of the dynamic nature of cancer‐associated pain and the substantial variation in individual responsiveness to opioids, there may be a need for ongoing adjustments with close monitoring of outcomes (analgesia, adverse effects, activity, and affect) to achieve an individualized tolerated and effective analgesic response.…”

Patient Perspective on the Management of Cancer Pain in Spain

“…The body areas where patients felt most pain varied depending on the primary cancer, in agreement with reports by others ( 18 ). Overall pain prevalence has also been found to vary based on primary cancer ( 14 , 17 ); however, we did not evaluate this due to the data being aggregated.…”