Tailored Treatment for Breakthrough Cancer Pain (BTcP): Is it an Open Issue?

2019 ◽  
Author(s):  
Caterina Magnani
Keyword(s):  
Cancer Pain ◽  
Breakthrough Cancer Pain ◽  
Tailored Treatment ◽  
Open Issue

Breakthrough cancer pain tailored treatment: which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer

2018 ◽  
Vol 94 (1116) ◽  
pp. 566-570 ◽  
Author(s):  
Caterina Magnani ◽  
Diana Giannarelli ◽  
Alice Calvieri ◽  
Ana Dardeli ◽  
Giovanni Eusepi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pharmacological Treatment ◽  
Cross Sectional Study ◽  
Terminal Cancer ◽  
Sectional Study ◽  
Cross Sectional ◽  
Breakthrough Cancer Pain ◽  
Short Acting ◽  
Tailored Treatment ◽  
Intravenous Morphine

BackgroundVarious options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient’s ability to take medication.ObjectiveThe goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer.MethodsA prospective, cross-sectional study was carried out among 1180 patients who were receiving palliative care programmes. Patients were recruited if they had a diagnosis of BTcP and had been prescribed rescue opioids. Variables that might influence the BTcP treatment were assessed.ResultsOne hundred and forty-nine eligible patients were enrolled; 59.1% of patients received short-acting oral morphine (OM), 27.5% transmucosal immediate-release fentanyl (TIRF) and 13.4% parenteral morphine for BTcP treatment. Short-acting OM prescription was related to background pain treatment with OM <60  mg daily (p<0.0001) and to home-care setting of assistance (p=0.004). Continuous intravenous morphine infusion and the presence of a vascular access were the main factors related to intravenous morphine prescription for BTcP. TIRF use was mainly related to background opioid dosage and the patient’s self-sufficiency in taking medication.ConclusionIn clinical practice, the factors that most influenced the pharmacological treatment for BTcP were baseline opioid dosage, setting of assistance and self-ability to take medication. Further research is needed to improve the knowledge on tailored BTcP treatment.

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

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 PecFent: gel-based nasal fentanyl for breakthrough cancer pain

Prescriber ◽  
2011 ◽  
Vol 22 (6) ◽  
pp. 20-22
Author(s):  
Steve Chaplin ◽  
Monica Chogle ◽  
William Campbell
Keyword(s):  
Cancer Pain ◽  
Breakthrough Cancer Pain
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