Effect of Opioid Infusion Rate for the Reduction of Breakthrough Cancer Pain in Patients With Cancer

2020 ◽  
Author(s):  
Keyword(s):  
Cancer Pain ◽  
Infusion Rate ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer

Breakthrough cancer pain (BTcP) management: a review of international and national guidelines

2018 ◽  
Vol 8 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Andrew Neil Davies ◽  
Frank Elsner ◽  
Marilène Jeanne Filbet ◽  
Josep Porta-Sales ◽  
Carla Ripamonti ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Rescue Medication ◽  
Low Grade ◽  
National Guidelines ◽  
International Consensus ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Personal Opinion ◽  
Diagnosis Criteria ◽  
Current Guidelines

ObjectiveBreakthrough cancer pain (BTcP) is common and has a significant impact on the quality of life of patients with cancer. This review compares current national/international BTcP guidelines in order to identify disparities and priorities for further research.MethodsRelevant guidelines were identified using searches of PubMed, the National Guideline Clearinghouse, the internet (commercial search engines), and correspondence with key opinion leaders and relevant pharmaceutical companies. Identified guidelines were compared, using the Association for Palliative Medicine of Great Britain and Ireland recommendations as the ‘reference’ guideline.ResultsTen specific BTcP guidelines were identified/reviewed, as well as major international generic cancer pain guidelines. In general, there was good agreement between the specific BTcP guidelines, although there remain some differences in terms of definition, diagnostic criteria and treatment of BTcP. Disparities between the different BTcP guidelines invariably reflect personal opinion rather than research evidence. Generic cancer pain guidelines continue to support the use of oral opioids as rescue medication, while specific BTcP guidelines invariably endorse the use of transmucosal opioids as rescue medication.ConclusionCurrent guidelines agree on many aspects of the management of BTcP. However, the evidence to support current guidelines remains low grade, and so more research is needed in this area of care. Moreover, there needs to be an international consensus on the definition and diagnosis criteria of BTcP.

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

2018 ◽  
Author(s):  
Jaime Boceta ◽  
Daniel Samper ◽  
Alejandro de la Torre ◽  
Rainel Sánchez-de la Rosa ◽  
Gloria González
Keyword(s):  
Cancer Pain ◽  
Breakthrough Pain ◽  
Eastern Cooperative Oncology Group ◽  
Mobile App ◽  
Public Hospitals ◽  
Additional Patient ◽  
Educational Content ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Clinical Records

BACKGROUND Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). OBJECTIVE This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES·DIO developed for the management of patients with BTcP. METHODS This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. RESULTS Of the 175 physicians, 96% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80% (140/175) of physicians. The majority (157/175, 90%) answered that App INES·DIO was well designed and 94% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients’ clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES·DIO. CONCLUSIONS Our study showed that App INES·DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP.

scholarly journals Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study

2020 ◽  
pp. 1339-1349
Author(s):  
Francesco Pantano ◽  
Paolo Manca ◽  
Grazia Armento ◽  
Tea Zeppola ◽  
Angelo Onorato ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Clinical Features ◽  
Learning Algorithm ◽  
Large Data ◽  
Optimal Dose ◽  
Rapid Onset ◽  
Opioid Use ◽  
Data Set ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer

PURPOSE A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. METHODS Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use. RESULTS Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy. CONCLUSION This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.

Improved patient functioning after treatment of breakthrough cancer pain: an open-label study of fentanyl buccal tablet in patients with cancer pain

2015 ◽  
Vol 23 (7) ◽  
pp. 2135-2143 ◽  
Author(s):  
Andrew Davies ◽  
Ulrich R. Kleeberg ◽  
Jerzy Jarosz ◽  
Sebastiano Mercadante ◽  
Philippe Poulain ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Patient Functioning ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer ◽  
Fentanyl Buccal Tablet ◽  
Buccal Tablet

Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer

2016 ◽  
Vol 6 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Marianne Jensen Hjermstad ◽  
Stein Kaasa ◽  
Augusto Caraceni ◽  
Jon H Loge ◽  
Tore Pedersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Breakthrough Cancer Pain ◽  
Patients With Cancer

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
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