Abstract
PurposeThe 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.MethodsA 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.ResultsNinety-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).ConclusionIndividualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug.Trial registrationThis study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.
Highlights
Breakthrough cancer pain (BTcP) is frequent in cancer patients and it significantly impairs their quality of life (QoL) [1,2,3]
A prospective, observational, multicenter study was conducted in patients with advanced cancer who were assisted by Spanish Palliative Care teams
Inclusion criteria were age ≥ 18 years, diagnosis of advanced cancer, clinically estimated survival ≥3 months, attendance by palliative care units, background cancer pain controlled with opioids, diagnosis of BTcP using the Davies algorithm [4], and signed informed consent
Summary
Breakthrough cancer pain (BTcP) is frequent in cancer patients and it significantly impairs their quality of life (QoL) [1,2,3]. It is usually defined as a transient pain exacerbation, which is spontaneous or triggered, in spite of a stable and adequately controlled background pain. In observational studies, BTcP was predictable in 30–44% of patients, achieved its peak intensity in less than 10 min in more than 60% of episodes, had a Support Care Cancer (2021) 29:4799–4807 mean duration of 30 min, and usually interfered with patient QoL [3, 6, 7]
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