Breakthrough cancer pain tailored treatment: which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer. Issue 1116 (13th October 2018)

• Record Type: Journal Article
• Authors: Magnani, Caterina; Giannarelli, Diana; Calvieri, Alice; Dardeli, Ana; Eusepi, Giovanni; Restuccia, Maria Rosa; Mastroianni, Chiara; Casale, Giuseppe
• Is Part Of: Postgraduate medical journal. Volume 94:Issue 1116(2018)
• Page Start: 566
• Page End: 570
• Publication Date: 2018-10-13
• Subjects: pain management -- adult palliative care -- breakthrough pain -- cancer pain -- fentanyl -- oral morphine; Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2018-135659
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract: Background: Various 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. Objective: The 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. Methods: A 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. Results: One 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. Conclusion: In 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.