Abstract
Aim: To characterize breakthrough cancer pain (BTcP) in patients with lung cancer. Methods: This was a secondary analysis of multicenter study of patients with BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, the mean time to meaningful pain relief after taking medication, satisfaction and adverse effects were assessed. Results: 1087 patients with lung cancer were examined. In comparison with other tumors, patients with lung cancer showed: higher background pain intensity (p = 0.006), lower opioid doses (p = 0.005), higher intensity of BTcP (p = 0.005), movement (79.5%) and cough (8.2%), as principal triggers for predictable BTcP (p < 0.009), larger BTcP interference with daily activity (p = 0.0001), higher use of adjuvants (p = 0.0001). No relevant differences in the other parameters examined were found. Conclusion: Patients with lung cancer have their own peculiarities, including higher basal and BTcP pain intensity and the use of more adjuvant drugs for background pain. The most frequent triggers for predictable BTcP are movement and cough. Future studies should be performed to analyze the prevalence of BTcP in patients with different lung cancers as well as the optimal management strategy for background pain and BTcP.
Highlights
Lung cancer is the most important cause of cancer-related death in the world
The mean background pain intensity was 3.1 (Standard Deviation 1.78), which was higher than the pain intensity found in other tumors (p = 0.006)
All these findings suggest that clinicians resort to other drugs to improve opioid analgesia, rather than increasing the doses of opioids, as pain would be less responsive to opioid drugs [9]
Summary
Lung cancer is the most important cause of cancer-related death in the world. In 2016, about 220,000 new diagnoses of lung cancer were reported and about 150,000 of patients died for the disease. For every 100,000 people, 56 new cases were diagnosed and 39 died. Despite the improvement in diagnosis and treatment, this population has a poor prognosis. About 59% have a 5-year survival after diagnosis and more than 5,000,000 of patients are alive in the United States [1,2,3]. The majority of patients with lung cancer experience burdensome symptoms associated to disease or treatments, which occur in the advanced stage of their illness. Pain is one of the most distressing symptoms because of its debilitating effects, which produce depression and anxiety [4]
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