Abstract
We aimed to evaluate the prevalence, characteristics and impact of breakthrough pain (BTP) in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain using a multicenter, observational, cross-sectional, multidisciplinary study. Investigators had to record all patients seen at the clinic during 1 month, determine whether the patients had cancer pain, and apply the Davies algorithm to ascertain whether the patients were suffering from BTP. Of the 3,765 patients with cancer, 1,117 (30%) had cancer-related pain, and of these patients, 539 had BTP (48%, 95%CI:45–51). The highest prevalence was found in patients from palliative care (61%, 95%CI:54–68), and the lowest was found in those from hematology (25%, 95%CI:20–31). Prevalence varied also according to sex and type of tumor. According to the Alberta Breakthrough Pain Assessment Tool duration, timing, frequency, location, severity, quality, causes, and predictability of the BTP varied greatly among these patients. BTP was moderate (Brief Pain Inventory [BPI]-severity median score = 5.3), and pain interference was moderate (BPI-interference median score = 6.1) with a greater interference with normal work, general activity, and enjoyment of life. Patients with BTP showed a mean ± standard deviation score of 28.5 ± 8.0 and 36.9 ± 9.5 in the physical and mental component, respectively, of the SF-12 questionnaire. In conclusion, prevalence of BTP among patients exhibiting cancer-related pain is high. Clinical presentation is heterogeneous, and therefore, BTP cannot be considered as a single entity. However, uniformly BTP has an important impact on a patient’s functionality, which supports the need for early detection and treatment.
Highlights
Breakthrough pain (BTP) has been defined as a “transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger despite relatively stable and adequately controlled background pain”[1]
The primary objective of this study was to evaluate the prevalence of BTP in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain
The highest prevalence was found in patients from palliative care (61%, 95% CI: 54 to 68), and the lowest was found in those from hematology (25%, 95% CI: 20 to 31); by the type of tumor, the highest prevalence was found in patients with pancreatic cancer (71%, 95% CI: 57 to 85) and colorectal cancer (62%, 95% CI: 54 to 71), and the lowest prevalence was found among patients with multiple myeloma (32%, 95% CI: 26 to 38) and lymphoma (22%, 95% CI: 12 to 33) (Fig. 2)
Summary
Breakthrough pain (BTP) has been defined as a “transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger despite relatively stable and adequately controlled background pain”[1]. In a study conducted on a sample of patients with advanced cancer attending the palliative care outpatient clinic of a university hospital in Lleida, Canal-Sotelo et al recently reported a prevalence of BTP of 39% and great variability in the type of presentation using a retrospective evaluation with the Davies algorithm[16]. The primary objective of this study was to evaluate the prevalence of BTP in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain (namely, medical oncology, radiation oncology, hematology, pain units, and palliative care units). Secondary objectives included evaluating the 1-month cumulative incidence of BTP, describing the clinical characteristics of patients with undiagnosed BTP, and evaluating the impacts on daily activities and quality of life
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