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Breakthrough cancer pain tailored treatment: which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer
  1. Caterina Magnani1,
  2. Diana Giannarelli2,
  3. Alice Calvieri3,
  4. Ana Dardeli3,
  5. Giovanni Eusepi3,
  6. Maria Rosa Restuccia3,
  7. Chiara Mastroianni4,
  8. Giuseppe Casale5
  1. 1 Research Department, Palliative Care Unit, Antea Associazione, Rome, Italy
  2. 2 Biostatistics Department, Istituto Regina Elena, Rome, Italy
  3. 3 Hospice Care Department, Antea, Rome, Italy
  4. 4 Educational Department, Palliative Care Unit, Antea Associazione, Rome, Italy
  5. 5 Health and Scientific Management, Palliative Care Unit, Antea Associazione, Rome, Italy
  1. Correspondence to Dr Caterina Magnani, Research Department, Palliative Care Unit, Antea, Rome 00135, Italy; c.magnani{at}antea.net

Abstract

Background Various options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient’s ability to take medication.

Objective The goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer.

Methods A prospective, cross-sectional study was carried out among 1180 patients who were receiving palliative care programmes. Patients were recruited if they had a diagnosis of BTcP and had been prescribed rescue opioids. Variables that might influence the BTcP treatment were assessed.

Results One hundred and forty-nine eligible patients were enrolled; 59.1% of patients received short-acting oral morphine (OM), 27.5% transmucosal immediate-release fentanyl (TIRF) and 13.4% parenteral morphine for BTcP treatment. Short-acting OM prescription was related to background pain treatment with OM <60  mg daily (p<0.0001) and to home-care setting of assistance (p=0.004). Continuous intravenous morphine infusion and the presence of a vascular access were the main factors related to intravenous morphine prescription for BTcP. TIRF use was mainly related to background opioid dosage and the patient’s self-sufficiency in taking medication.

Conclusion In clinical practice, the factors that most influenced the pharmacological treatment for BTcP were baseline opioid dosage, setting of assistance and self-ability to take medication. Further research is needed to improve the knowledge on tailored BTcP treatment.

  • pain management
  • adult palliative care
  • breakthrough pain
  • cancer pain
  • fentanyl
  • oral morphine

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Footnotes

  • Contributors CaM planned the study, wrote the protocol, wrote the final paper and submitted the article. DG did the statistical elaboration of the results. AC, AD, GE and MRR conducted the study. ChM reviewed the final paper. GS planned and coordinated the study.

  • Funding This work was supported by an unconditional grant from Molteni Farmaceutici. Molteni had no role in the design or conduct of the study; in the collection, management, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript. The content of this article is solely the responsibility of the authors. The authors report no other conflicts of interest.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local ethics committee (Comitato Etico Lazio 1) and was conducted in accordance with the international standards for clinical research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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