Breakthrough cancer pain tailored treatment: Which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer

Caterina Magnani, Diana Giannarelli, Alice Calvieri, Ana Dardeli, Giovanni Eusepi, Maria Rosa Restuccia, Chiara Mastroianni, Giuseppe Casale

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)566-570
JournalPostgraduate Medical Journal
Volume94
Issue number1116
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Breakthrough cancer pain tailored treatment: Which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer'. Together they form a unique fingerprint.

  • Cite this