R12 - Survey on prevalence and management of breakthrough cancer pain: a single center experience

Abstract

Background: Breakthrough cancer pain(BTcP)is a transitory, acute pain that occurs despite the use of analgesia(treated by strong opiod)to control chronic pain. BTcP may arise spontaneously or be provoked by certain movements or activities(voluntary or involuntary).The aim of our survey was to evaluate the prevalence and the management of BTcP in our patients(pts). Patients and methods: From September 2014 to September 2015 we consecutively enrolled 133 pts refereed to ambulatory of pain and palliative care of Medical Oncology Department of Varese.A detailed questionnaire regarding pain control and BTcP was administered to those pts.To detect chronic pain and for BTcP assessment we used a numeric rate scale(NRS).Follow up questionnaire regarding the effectiveness of therapy was also administered.Mean age was 66 years-old(range:33-84),85 pts were male.Performance Status(ECOG)was 0-1 in 47%pts,while 2-3 in 63%pts.Primary cancer site was:lung(28%),urogenital(16%), colorectal(14%),bilio-pancreatic(11%),breast(10%),head-neck(10%),esophagus-gastric (5%),skin(3%),hematological malignancies(3%).92% pts had stage IV disease.Metastatic sites were:bone(49%),lung(41%),liver(39%),regional lymph nodes(48%),peritoneum(8%) and central nervous system(5.5%). Results: Median chronic pain measured according to NRS scale was less than 4 in 100%of patients Nociceptive and neuropathic pain was both reported by 82% of pts and neuropathic alone in 18%.96%of pts were treated with opioid(70% strong, 30% weak),while 4% of pts were treated with non-opioid drugs(NSAIDs).Opioid therapy for chronic pain was administered with oral(70,5%), transdermal(26.5%)and subcutaneous(3%)formulation.Adjuvant drugs were associated in 34% of pts. BTcP was reported by 85%of pts.In particular, our patients referred on average 2,5 episodes of BTcP every day(from 1 up to 7).Mean intensity was 8.2,from 7 up to 10 using NRS scale. BTcP was treated with ROO (rapid onset opioids)(55%),oral or subcutaneous morphine(30%), oxycodone(rapid release)(10%) and with non-opioid drugs(5%).Constipation, nausea/vomiting, drowsiness and xerostomy didn't get worse by the treatment for BTcP. No statistical correlation was found between number of BTcP and mean intensity and site of primary cancer, nor site of metastasis.95% of pts reffered satisfaction of BTcP therapy. Conclusions: This study shows a very high prevalence of BTP in our pts.Treatment administrered for BTcP was effective in our pts without addition of side effects.