Cancer Res Treat.  2016 Apr;48(2):768-774. 10.4143/crt.2015.087.

A Korean Nationwide Survey for Breakthrough Cancer Pain in an Inpatient Setting

• Baek SK
• Kim DY
• Kang SY
• Sym SJ
• Kim YS
• Lee JY

• KMID: 2454355
• DOI: http://doi.org/10.4143/crt.2015.087

Abstract

PURPOSE
We evaluated the prevalence and characteristics of breakthrough cancer pain (BTcP) in Korean patients admitted with cancer pain.
MATERIALS AND METHODS
In-hospital patients with cancer pain completed a questionnaire concerning severity of background cancer pain (BCP), prevalence and treatment for BTcP, sleep disorders, and satisfaction with cancer pain treatment. Medical records showing medications for BCP and BTcP were also evaluated.
RESULTS
Total 609 patients with controlled BCP enrolled. Mean age of the patients was 59.5 years old, and 59% were male. Of all patients, 177 (29%) complained of BTcP. No clinical characteristic predicted BTcP. Of the 177 patients with BTcP, 56% did not receive treatment for BTcP. Patients with BTcP showed significant association with a sleep disorder and dissatisfaction with pain control, compared to those without BTcP (p < 0.0001 and p=0.0498, respectively). Oxycodone-immediate release was the most commonly used short-acting analgesic, followed by intravenous morphine.
CONCLUSION
The prevalence of BTcP was 29% in patients admitted with controlled BCP. Although the patients had well-controlled BCP, BTcP showed association with a lower quality of life in patients with cancer. More medical attention is needed for detection and management of BTcP.

Keyword

Breakthrough cancer pain; Prevalence; Characteristics; Quality of life

MeSH Terms

Humans
Inpatients*
Male
Medical Records
Morphine
Prevalence
Quality of Life
Sleep Wake Disorders
Morphine

Reference

References

1. Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manage. 2014; 47:57–76.

2. Portenoy RK, Hagen NA. Breakthrough pain: definition and management. Oncology (Williston Park). 1989; 3(8 Suppl):25–9.

3. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990; 41:273–81.

4. Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G; Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain. 2009; 13:331–8.

5. Zeppetella G, O'Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manage. 2000; 20:87–92.

6. Davies A, Zeppetella G, Andersen S, Damkier A, Vejlgaard T, Nauck F, et al. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain. 2011; 15:756–63.

7. Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA. Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 2: impact on function, mood, and quality of life. J Opioid Manag. 2010; 6:109–16.

8. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999; 81:129–34.

9. Zucco F, Bonezzi C, Fornasari D. Breakthrough cancer pain (BTcP): a synthesis of taxonomy, pathogenesis, therapy, and good clinical practice in adult patients in Italy. Adv Ther. 2014; 31:657–82.

10. Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, et al. Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manage. 2013; 46:619–28.

11. Bedard G, Davies A, McDonald R, Hawley P, Buchanan A, Popovic M, et al. Breakthrough cancer pain: a comparison of surveys with European and Canadian patients. Support Care Cancer. 2015; 23:791–6.

12. Hong SH, Roh SY, Kim SY, Shin SW, Kim CS, Choi JH, et al. Change in cancer pain management in Korea between 2001 and 2006: results of two nationwide surveys. J Pain Symptom Manage. 2011; 41:93–103.

13. Raj SX, Thronaes M, Brunelli C, Hjermstad MJ, Klepstad P, Kaasa S. A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer. 2014; 22:1965–71.

14. Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain. 2010; 149:476–82.

15. Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson LE, Fisher K, et al. The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a delphi process and patient think-aloud interviews. J Pain Symptom Manage. 2008; 35:136–52.

16. Sperlinga R, Campagna S, Berruti A, Laciura P, Ginosa I, Paoletti S, et al. Alberta Breakthrough Pain Assessment Tool: a validation multicentre study in cancer patients with breakthrough pain. Eur J Pain. 2015; 19:881–8.

17. Zeppetella G, Ribeiro MD. Episodic pain in patients with advanced cancer. Am J Hosp Palliat Care. 2002; 19:267–76.

18. Caraceni A, Bertetto O, Labianca R, Maltoni M, Mercadante S, Varrassi G, et al. Episodic (breakthrough) pain prevalence in a population of cancer pain patients. Comparison of clinical diagnoses with the QUDEI: Italian questionnaire for intense episodic pain. J Pain Symptom Manage. 2012; 43:833–41.

19. Schug SA, Chandrasena C. Pain management of the cancer patient. Expert Opin Pharmacother. 2015; 16:5–15.

20. Zeppetella G, Davies AN. Opioids for the management of breakthrough pain in cancer patients. Cochrane Database Syst Rev. 2013; 10:CD004311.

21. Mercadante S. Pharmacotherapy for breakthrough cancer pain. Drugs. 2012; 72:181–90.

22. Davis MP. Fentanyl for breakthrough pain: a systematic review. Expert Rev Neurother. 2011; 11:1197–216.