Factors influencing the use of opioids for breakthrough cancer pain: A secondary analysis of the IOPS‐MS study

2018 ◽  
Vol 23 (4) ◽  
pp. 719-726 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Claudio Adile ◽  
Francesco Masedu ◽  
Paolo Marchetti ◽  
Andrea Costanzi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Secondary Analysis ◽  
Breakthrough Cancer Pain ◽  
Factors Influencing

scholarly journals Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4018
Author(s):  
Marco Cascella ◽  
Anna Crispo ◽  
Gennaro Esposito ◽  
Cira Antonietta Forte ◽  
Sergio Coluccia ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Specific Activity ◽  
Multiple Correspondence Analysis ◽  
Univariate Analysis ◽  
Secondary Analysis ◽  
Hierarchical Classification ◽  
Onset Time ◽  
Rapid Onset ◽  
Statistical Technique ◽  
Breakthrough Cancer Pain

Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that “breaks through” a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) is a subtype of BTcP that occurs in the absence of any specific activity. Since NP-BTcP has an important clinical impact, this analysis is aimed at characterizing the NP-BTcP phenomenon through a multidimensional statistical technique. This is a secondary analysis based on the Italian Oncologic Pain multiSetting—Multicentric Survey (IOPS-MS). A correlation analysis was performed to characterize the NP-BTcP profile about its intensity, number of episodes per day, and type. The multiple correspondence analysis (MCA) determined the identification of four groups (phenotypes). A univariate analysis was performed to assess differences between the four phenotypes and selected covariates. The four phenotypes represent the hierarchical classification according to the status of NP-BTcP: from the best (phenotype 1) to the worst (phenotype 4). The univariate analysis found a significant association between the onset time >10 min in the phenotype 1 (37.3%)’ vs. the onset > 10 min in phenotype 4 (25.8%) (p < 0.001). Phenotype 1 was characterized by the gastrointestinal type of cancer (26.4%) with respect to phenotype 4, where the most frequent cancer affected the lung (28.8%) (p < 0.001). Phenotype 4 was mainly managed with rapid-onset opioids, while in phenotype 1, many patients were treated with oral, subcutaneous, or intravenous morphine (56.4% and 44.4%, respectively; p = 0.008). The ability to characterize NP-BTcP can offer enormous benefits for the management of this serious aspect of cancer pain. Although requiring validation, this strategy can provide many indications for identifying the diagnostic and therapeutic gaps in NP-BTcP management.

scholarly journals Multidimensional Statistical Technique for Interpreting the Spontaneous breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

2021 ◽  
Author(s):  
Marco Cascella ◽  
Anna Crispo ◽  
Gennaro Esposito ◽  
Cira Antonietta Forte ◽  
Sergio Coluccia ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Specific Activity ◽  
Univariate Analysis ◽  
Secondary Analysis ◽  
Hierarchical Classification ◽  
Onset Time ◽  
Rapid Onset ◽  
Statistical Technique ◽  
Breakthrough Cancer Pain ◽  
The Status

Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) is a subtype of BTcP that occurs in the absence of any specific activity. Since NP-BTcP has an important clinical impact, this analysis is aimed at characterizing the NP-BTcP phenomenon through a multidimensional statistical technique. This is a secondary analysis based on the Italian Oncologic Pain multiSetting - Multicentric Survey (IOPS-MS) . A correlation analysis was performed to characterize NP-BTcP profile about its intensity, number of episodes per day, and type. The Multidimensional Correspondence Analysis (MCA) determined the identification of 4 groups (Phenotypes). A univariate analysis was performed to assess differences between the 4 Phenotypes and selected covariates. The four phenotypes represent the hierarchical classification according to the status of NP-BTcP: from the best (Phenotype 1) to the worst (Phenotype 4). The univariate analysis found a significant association between the onset time &amp;gt;10 min in the Phenotype 1 (37.3%) vs. the onset &le; 10 min in Phenotype 4 (74.2%) (p&amp;lt;0.001). The Phenotype 1 was characterized by gastrointestinal type of cancer (26.4%) respect to Phenotype 4 where the most frequent cancer affected the lung (28.8%) (p&amp;lt;0.001). Phenotype 4 was mainly managed with rapid onset opioids, while in Phenotype 1 many patients were treated with oral, subcutaneous, or intravenous morphine (56.4% and 44.4%, respectively; p=0.008). The ability to characterize NP-BTcP can offer enormous benefits for the management of this serious aspect of cancer pain. This strategy can provide many indications for identifying the diagnostic and therapeutic gaps on NP-BTcP management.

scholarly journals Impact of individualized management of breakthrough cancer pain on quality of life in advanced cancer patients: CAVIDIOPAL study

2021 ◽  
Author(s):  
Albert Tuca Rodríguez ◽  
Miguel Núñez Viejo ◽  
Pablo Maradey ◽  
Jaume Canal-Sotelo ◽  
Plácido Guardia Mancilla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Advanced Cancer ◽  
Low Doses ◽  
Breakthrough Cancer Pain ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Individualized Management ◽  
The Impact

Abstract Purpose The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. Methods A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. Results Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001–1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227–13.873). Conclusion Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. Trial registration This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

Understanding the Chameleonic Breakthrough Cancer Pain

Drugs ◽  
2021 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Russell K. Portenoy
Keyword(s):  
Cancer Pain ◽  
Breakthrough Cancer Pain

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

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1058
Author(s):  
Sebastiano Mercadante ◽  
Marco Maltoni ◽  
Domenico Russo ◽  
Claudio Adile ◽  
Patrizia Ferrera ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Oral Morphine ◽  
Epidemiological Data ◽  
Low Doses ◽  
Advanced Cancer Patients ◽  
Breakthrough Cancer Pain ◽  
Background Pain ◽  
The Mean ◽  
Oral Morphine Equivalent

The aim of this study was to assess the prevalence and characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain. A consecutive sample of advanced cancer patients receiving less than 60 mg/day of oral morphine equivalent (OME) was selected. Epidemiological data, background pain intensity, and current analgesic therapy were recorded. The presence of BTcP was diagnosed according to a standard algorithm. The number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, satisfaction with BTcP medication, and time to meaningful pain relief were collected. A total of 126 patients were screened. The mean intensity of background pain was 2.71 (1.57), and the mean OME was 28.5 mg/day (SD15.8). BTP episodes were recorded in 88 patients (69.8%). The mean number/day of BTP episodes was 4.1 (SD 7.1, range 1–30). In a significant percentage of patients, BTcP was both predictable and unpredictable (23%). The BTcP onset was less than 20 min in the majority of patients. The mean duration of untreated episodes was 47.5 (SD 47.6) minutes. The mean time to meaningful pain relief after taking a BTcP medication was >20 min in 44.5% of patients. The efficacy of BTcP medication was not considered good in more than 63% of patients. Gender (females) (OR = 4.16) and lower Karnofsky (OR = 0.92) were independently associated with BTcP. A higher number of BTcP episodes/day was associated with gender (females) (p = 0.036), short duration of BTcP (p = 0.005), poorer efficacy of BTcP medication (none or mild) (p = 0.001), and late meaningful pain relief (p = 0.024). The poor efficacy of BTcP medication was independently associated with a higher number of episodes/day (OR = 0.22). In patients who were receiving low doses of opioids, BTcP prevalence was 69.8%. Many patients did not achieve a sufficient level of satisfaction with BTcP medications, particularly with oral morphine. Data also suggest that better optimization of background analgesia, though apparently acceptable, may limit the number of BTcP episodes.

scholarly journals Management of breakthrough cancer pain (BTcP) in patients with bone metastases of solid tumors

2016 ◽  
Vol 27 ◽  
pp. iv106
Author(s):  
G.P. Spinelli ◽  
E. Gozzi ◽  
V. Stati ◽  
E. Miele ◽  
L. Rossi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Bone Metastases ◽  
Solid Tumors ◽  
Breakthrough Cancer Pain
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