Factors influencing the clinical presentation of breakthrough pain in cancer patients

S. Mercadante, P. Marchetti, A. Cuomo, A. Caraceni, R.D. Mediati, R. Vellucci, M. Mammucari, S. Natoli, M. Lazzari, M. Dauri, C. Adile, M. Airoldi, G. Azzarello, M. Bandera, L. Blasi, G. Cartenì, B. Chiurazzi, B.V.P. Costanzo, D. Degiovanni, F. FuscoV. Guardamagna, V. Iaffaioli, S. Liguori, L. Palermo, S. Mameli, F. Masedu, R. Mattioli, T. Mazzei, R.M. Melotti, V. Menardo, D. Miotti, S. Moroso, G. Pascoletti, S. De Santis, R. Orsetti, A. Papa, S. Ricci, E. Scelzi, M. Sofia, G. Tonini, A. Valle, F. Aielli, IOPS-MS Study Group

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Original languageEnglish
JournalCancers
Volume10
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Breakthrough Pain
Neoplasms
Pain
Cancer Pain

Keywords

  • Breakthrough pain
  • Cancer
  • Palliative care
  • Supportive care
  • analgesic agent
  • antiinflammatory agent
  • buprenorphine
  • codeine
  • fentanyl
  • hydromorphone
  • methadone
  • morphine
  • naloxone plus oxycodone
  • opiate
  • oxycodone
  • paracetamol
  • tapentadol
  • tramadol
  • adult
  • aged
  • analgesia
  • Article
  • breakthrough pain
  • cancer diagnosis
  • cancer patient
  • clinical feature
  • confusion
  • constipation
  • daily life activity
  • female
  • head and neck cancer
  • headache
  • human
  • Karnofsky Performance Status
  • major clinical study
  • male
  • metastasis
  • multicenter study
  • nausea
  • neuropathic pain
  • pain intensity
  • unspecified side effect
  • vomiting

Cite this

Factors influencing the clinical presentation of breakthrough pain in cancer patients. / Mercadante, S.; Marchetti, P.; Cuomo, A.; Caraceni, A.; Mediati, R.D.; Vellucci, R.; Mammucari, M.; Natoli, S.; Lazzari, M.; Dauri, M.; Adile, C.; Airoldi, M.; Azzarello, G.; Bandera, M.; Blasi, L.; Cartenì, G.; Chiurazzi, B.; Costanzo, B.V.P.; Degiovanni, D.; Fusco, F.; Guardamagna, V.; Iaffaioli, V.; Liguori, S.; Palermo, L.; Mameli, S.; Masedu, F.; Mattioli, R.; Mazzei, T.; Melotti, R.M.; Menardo, V.; Miotti, D.; Moroso, S.; Pascoletti, G.; De Santis, S.; Orsetti, R.; Papa, A.; Ricci, S.; Scelzi, E.; Sofia, M.; Tonini, G.; Valle, A.; Aielli, F.; Group, IOPS-MS Study.

In: Cancers, Vol. 10, No. 6, 2018.

Research output: Contribution to journalArticle

Mercadante, S, Marchetti, P, Cuomo, A, Caraceni, A, Mediati, RD, Vellucci, R, Mammucari, M, Natoli, S, Lazzari, M, Dauri, M, Adile, C, Airoldi, M, Azzarello, G, Bandera, M, Blasi, L, Cartenì, G, Chiurazzi, B, Costanzo, BVP, Degiovanni, D, Fusco, F, Guardamagna, V, Iaffaioli, V, Liguori, S, Palermo, L, Mameli, S, Masedu, F, Mattioli, R, Mazzei, T, Melotti, RM, Menardo, V, Miotti, D, Moroso, S, Pascoletti, G, De Santis, S, Orsetti, R, Papa, A, Ricci, S, Scelzi, E, Sofia, M, Tonini, G, Valle, A, Aielli, F & Group, IOPS-MSS 2018, 'Factors influencing the clinical presentation of breakthrough pain in cancer patients', Cancers, vol. 10, no. 6. https://doi.org/10.3390/cancers10060175
Mercadante, S. ; Marchetti, P. ; Cuomo, A. ; Caraceni, A. ; Mediati, R.D. ; Vellucci, R. ; Mammucari, M. ; Natoli, S. ; Lazzari, M. ; Dauri, M. ; Adile, C. ; Airoldi, M. ; Azzarello, G. ; Bandera, M. ; Blasi, L. ; Cartenì, G. ; Chiurazzi, B. ; Costanzo, B.V.P. ; Degiovanni, D. ; Fusco, F. ; Guardamagna, V. ; Iaffaioli, V. ; Liguori, S. ; Palermo, L. ; Mameli, S. ; Masedu, F. ; Mattioli, R. ; Mazzei, T. ; Melotti, R.M. ; Menardo, V. ; Miotti, D. ; Moroso, S. ; Pascoletti, G. ; De Santis, S. ; Orsetti, R. ; Papa, A. ; Ricci, S. ; Scelzi, E. ; Sofia, M. ; Tonini, G. ; Valle, A. ; Aielli, F. ; Group, IOPS-MS Study. / Factors influencing the clinical presentation of breakthrough pain in cancer patients. In: Cancers. 2018 ; Vol. 10, No. 6.
@article{91452a2d02bd437e829166d60437444d,
title = "Factors influencing the clinical presentation of breakthrough pain in cancer patients",
abstract = "Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9{\%} of patients. In 30.5{\%} of patients BTP was predictable. There were 86.0{\%} of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8{\%} of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9{\%} of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. {\circledC} 2018 by the authors. Licensee MDPI, Basel, Switzerland.",
keywords = "Breakthrough pain, Cancer, Palliative care, Supportive care, analgesic agent, antiinflammatory agent, buprenorphine, codeine, fentanyl, hydromorphone, methadone, morphine, naloxone plus oxycodone, opiate, oxycodone, paracetamol, tapentadol, tramadol, adult, aged, analgesia, Article, breakthrough pain, cancer diagnosis, cancer patient, clinical feature, confusion, constipation, daily life activity, female, head and neck cancer, headache, human, Karnofsky Performance Status, major clinical study, male, metastasis, multicenter study, nausea, neuropathic pain, pain intensity, unspecified side effect, vomiting",
author = "S. Mercadante and P. Marchetti and A. Cuomo and A. Caraceni and R.D. Mediati and R. Vellucci and M. Mammucari and S. Natoli and M. Lazzari and M. Dauri and C. Adile and M. Airoldi and G. Azzarello and M. Bandera and L. Blasi and G. Carten{\`i} and B. Chiurazzi and B.V.P. Costanzo and D. Degiovanni and F. Fusco and V. Guardamagna and V. Iaffaioli and S. Liguori and L. Palermo and S. Mameli and F. Masedu and R. Mattioli and T. Mazzei and R.M. Melotti and V. Menardo and D. Miotti and S. Moroso and G. Pascoletti and {De Santis}, S. and R. Orsetti and A. Papa and S. Ricci and E. Scelzi and M. Sofia and G. Tonini and A. Valle and F. Aielli and Group, {IOPS-MS Study}",
note = "Cited By :2 Export Date: 6 February 2019 Correspondence Address: Mercadante, S.; Anesthesia and Intensive Care & Pain Relief and Supportive CareItaly; email: terapiadeldolore@lamaddalenanet.it Chemicals/CAS: buprenorphine, 52485-79-7, 53152-21-9; codeine, 76-57-3; fentanyl, 437-38-7; hydromorphone, 466-99-9, 71-68-1; methadone, 1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3; morphine, 52-26-6, 57-27-2; opiate, 53663-61-9, 8002-76-4, 8008-60-4; oxycodone, 124-90-3, 76-42-6; paracetamol, 103-90-2; tapentadol, 175591-09-0, 175591-23-8; tramadol, 27203-92-5, 36282-47-0 Funding details: Association du Syndrome de Lowe, ASL Funding details: National Cancer Institute, NCI Funding text 1: Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy Primary Care Unit, ASL RM1, Rome, Italy Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, and Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy Second Medical Oncology Division, Citt{\`a} della Salute e della Scienza Hospital of Turin, Turin, Italy Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy MedicalOncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, Varese, Italy MedicalOncology Unit, ARNAS Ospedale Civico-Di Cristina-Benfratelli, Palermo, Italy Medical Oncology, A.O.R.N. Cardarelli, Naples, Italy Palliative Care Unit, SAMO ONLUS, Catania, Italy Palliative Care Unit, ASL AL, Casale Monferrato, Italy Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, Genoa, Italy Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy References: Portenoy, R.K., Treatment of cancer pain (2011) Lancet, 377, pp. 2236-2247; Mercadante, S., The use of opioids for treatment of cancer pain (2015) Expert Opin. Pharmacother, 16, pp. 389-394; Portenoy, R.K., Hagen, N.A., Breakthrough pain: Definition, prevalence and characteristics (1990) Pain, 41, pp. 273-281; Portenoy, R.K., Payne, D., Jacobson, P., Breakthrough pain: Characteristics and impact in patients with cancer pain (1999) Pain, 81, pp. 129-134; Mercadante, S., Portenoy, R.K., Breakthrough cancer pain: Twenty-five years of study (2016) Pain, 157, pp. 2657-2663; Haugen, D.F., Hjermstad, M.J., Hagen, N., Caraceni, A., Kaasa, S., European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: A systematic literature review (2010) Pain, 149, pp. 476-482; L{\o}hre, E.T., Klepstad, P., Bennett, M.I., Brunelli, C., Caraceni, A., Fainsinger, R.L., Knudsen, A.K., Kaasa, S., European Association for Palliative Care Research Network. From “Breakthrough” to “Episodic” Cancer Pain? A European Association for Palliative Care Research Network Expert Delphi Survey toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations (2016) J. Pain Symptom Manag., 51, pp. 1013-1019; Mercadante, S., Marchetti, P., Cuomo, A., Mammucari, M., Caraceni, A., IOPS MS study Group. Breakthrough pain and its treatment: Critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group (2016) Support Care Cancer, 24, pp. 961-968; Mercadante, S., Valle, A., Porzio, G., Aielli, F., Adile, C., Ficorella, C., Raineri, M., Casuccio, A., Relationship between background cancer pain, breakthrough pain, and analgesic treatment: A preliminary study for a better interpretation of epidemiological and clinical studies (2013) Curr. Med. Res. Opin., 29, pp. 667-671; Davies, A., Zeppetella, G., Andersen, S., Damkier, A., Vejlgaard, T., Nauck, F., Radbruch, L., Buchanan, A., Multi-centre European study of breakthrough cancer pain: Characteristics and patient perceptions of current and potential management strategies (2011) Eur. J. Pain, 15, pp. 756-763; Mercadante, S., Lazzari, M., Reale, C., Cuomo, A., Fusco, F., Marchetti, P., Mediati, R.D., Caraceni, A., Italian Oncological Pain Survey (IOPS): A multicentre Italian study of breakthrough pain performed in different settings (2015) Clin. J. Pain, 31, pp. 214-221; Mercadante, S., Adile, C., Torta, R., Varetto, A., Fulfaro, F., Giarratano, A., Casuccio, A., Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients (2013) Curr. Med. Res. Opin., 29, pp. 93-97; Mercadante, S., Costanzo, B.V., Fusco, F., Butt{\`a}, V., Vitrano, V., Casuccio, A., Breakthrough pain in advanced cancer patients followed at home: A longitudinal study (2009) J. Pain Symptom Manag., 38, pp. 554-560; Mercadante, S., Zagonel, V., Breda, E., Arcara, C., Gebbia, V., Porzio, G., Aielli, F., Narducci, F., Breakthrough pain in oncology: A longitudinal study (2010) J. Pain Symptom Manag., 40, pp. 183-190; Mercadante, S., Marchetti, P., Cuomo, A., Caraceni, A., Mediati, R.D., Mammucari, M., Natoli, S., Airoldi, M., Breakthrough cancer pain: Preliminary data of the Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS) (2017) Adv. Ther., 34, pp. 120-135; Davies, A., Buchanan, A., Zeppetella, G., Porta-Sales, J., Likar, R., Weismayr, W., Slama, O., Poulain, P., Breakthrough cancer pain: An observational study of 1000 European oncology patients (2013) J. Pain Symptom Manag., 46, pp. 619-628; (1979) WHO Handbook for Reporting Results of Cancer Treatment, pp. 15-22. , WHO: Geneva, Switzerland; Narayana, A., Katz, N., Shillington, A.C., Stephenson, J.J., Harshaw, Q., Frye, C.B., Portenoy, R.K., National Breakthrough Pain Study: Prevalence, characteristics, and associations with health outcomes (2015) Pain, 156, pp. 252-259; Caraceni, A., Martini, C., Zecca, E., Portenoy, R.K., Ashby, M.A., Hawson, G., Jackson, K.A., Pisasale, M., Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey (2004) Palliat. Med., 18, pp. 177-183; Hjermstad, M.J., Kaasa, S., Caraceni, A., Loge, J.H., Pedersen, T., Haugen, D.F., Aass, N., European Palliative Care Research Collaborative (EPCRC). Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (2016) BMJ Support Palliat. Care, 6, pp. 344-352; Zeppetella, G., O’Doherty, C.A., Collins, S., Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice (2000) J. Pain Symptom Manag., 20, pp. 87-92; G{\'o}mez-Batiste, X., Madrid, F., Moreno, F., Gracia, A., Trelis, J., Nabal, M., Alcalde, R., Camell, H., Breakthrough cancer pain: Prevalence and characteristics in patients in Catalonia, Spain (2002) J. Pain Symptom Manag., 24, pp. 45-52; Greco, M.T., Corli, O., Montanari, M., Deandrea, S., Zagonel, V., Apolone, G., Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients. Results from the Cancer Pain Outcome Research Study Group (2011) Clin. J. Pain, 27, pp. 9-18; Caraceni, A., Bertetto, O., Labianca, R., Maltoni, M., Mercadante, S., Varrassi, G., Zaninetta, G., Lanata, L., Episodic (Breakthrough) pain prevalence in a population of cancer pain patients. Comparison of clinical diagnoses with the QUDEI—Italian questionnaire for intense episodic pain (2012) J. Pain Symptom Manag., 43, pp. 833-841; Mercadante, S., Villari, P., Ferrera, P., Casuccio, A., Optimization of opioid therapy for preventing incident pain associated with bone metastases (2004) J. Pain Symptom Manag., 28, pp. 505-510; Arthur, J., Yennurajalingam, S., Nguyen, L., Tanco, K., Chisholm, G., Hui, D., Bruera, E., The routine use of the Edmonton Classification System for Cancer Pain in an outpatient supportive care center (2015) Palliat. Support Care, 13, pp. 1185-1192; Davies, A.N., Vriens, J., Kennett, A., McTaggart, M., An observational study of oncology patients’ utilization of breakthrough pain medication (2008) J. Pain Symptom Manag., 35, pp. 406-411",
year = "2018",
doi = "10.3390/cancers10060175",
language = "English",
volume = "10",
journal = "Cancers",
issn = "2072-6694",
publisher = "MDPI AG",
number = "6",

}

TY - JOUR

T1 - Factors influencing the clinical presentation of breakthrough pain in cancer patients

AU - Mercadante, S.

AU - Marchetti, P.

AU - Cuomo, A.

AU - Caraceni, A.

AU - Mediati, R.D.

AU - Vellucci, R.

AU - Mammucari, M.

AU - Natoli, S.

AU - Lazzari, M.

AU - Dauri, M.

AU - Adile, C.

AU - Airoldi, M.

AU - Azzarello, G.

AU - Bandera, M.

AU - Blasi, L.

AU - Cartenì, G.

AU - Chiurazzi, B.

AU - Costanzo, B.V.P.

AU - Degiovanni, D.

AU - Fusco, F.

AU - Guardamagna, V.

AU - Iaffaioli, V.

AU - Liguori, S.

AU - Palermo, L.

AU - Mameli, S.

AU - Masedu, F.

AU - Mattioli, R.

AU - Mazzei, T.

AU - Melotti, R.M.

AU - Menardo, V.

AU - Miotti, D.

AU - Moroso, S.

AU - Pascoletti, G.

AU - De Santis, S.

AU - Orsetti, R.

AU - Papa, A.

AU - Ricci, S.

AU - Scelzi, E.

AU - Sofia, M.

AU - Tonini, G.

AU - Valle, A.

AU - Aielli, F.

AU - Group, IOPS-MS Study

N1 - Cited By :2 Export Date: 6 February 2019 Correspondence Address: Mercadante, S.; Anesthesia and Intensive Care & Pain Relief and Supportive CareItaly; email: terapiadeldolore@lamaddalenanet.it Chemicals/CAS: buprenorphine, 52485-79-7, 53152-21-9; codeine, 76-57-3; fentanyl, 437-38-7; hydromorphone, 466-99-9, 71-68-1; methadone, 1095-90-5, 125-56-4, 23142-53-2, 297-88-1, 76-99-3; morphine, 52-26-6, 57-27-2; opiate, 53663-61-9, 8002-76-4, 8008-60-4; oxycodone, 124-90-3, 76-42-6; paracetamol, 103-90-2; tapentadol, 175591-09-0, 175591-23-8; tramadol, 27203-92-5, 36282-47-0 Funding details: Association du Syndrome de Lowe, ASL Funding details: National Cancer Institute, NCI Funding text 1: Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena, Palermo, Italy Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, Rome, Italy Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute, IRCCS Foundation, Milan, Italy Palliative Care and Pain Therapy Unit, Careggi Hospital, Florence, Italy Primary Care Unit, ASL RM1, Rome, Italy Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, and Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy Second Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy MedicalOncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, Varese, Italy MedicalOncology Unit, ARNAS Ospedale Civico-Di Cristina-Benfratelli, Palermo, Italy Medical Oncology, A.O.R.N. Cardarelli, Naples, Italy Palliative Care Unit, SAMO ONLUS, Catania, Italy Palliative Care Unit, ASL AL, Casale Monferrato, Italy Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, Genoa, Italy Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy References: Portenoy, R.K., Treatment of cancer pain (2011) Lancet, 377, pp. 2236-2247; Mercadante, S., The use of opioids for treatment of cancer pain (2015) Expert Opin. Pharmacother, 16, pp. 389-394; Portenoy, R.K., Hagen, N.A., Breakthrough pain: Definition, prevalence and characteristics (1990) Pain, 41, pp. 273-281; Portenoy, R.K., Payne, D., Jacobson, P., Breakthrough pain: Characteristics and impact in patients with cancer pain (1999) Pain, 81, pp. 129-134; Mercadante, S., Portenoy, R.K., Breakthrough cancer pain: Twenty-five years of study (2016) Pain, 157, pp. 2657-2663; Haugen, D.F., Hjermstad, M.J., Hagen, N., Caraceni, A., Kaasa, S., European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: A systematic literature review (2010) Pain, 149, pp. 476-482; Løhre, E.T., Klepstad, P., Bennett, M.I., Brunelli, C., Caraceni, A., Fainsinger, R.L., Knudsen, A.K., Kaasa, S., European Association for Palliative Care Research Network. From “Breakthrough” to “Episodic” Cancer Pain? A European Association for Palliative Care Research Network Expert Delphi Survey toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations (2016) J. Pain Symptom Manag., 51, pp. 1013-1019; Mercadante, S., Marchetti, P., Cuomo, A., Mammucari, M., Caraceni, A., IOPS MS study Group. Breakthrough pain and its treatment: Critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group (2016) Support Care Cancer, 24, pp. 961-968; Mercadante, S., Valle, A., Porzio, G., Aielli, F., Adile, C., Ficorella, C., Raineri, M., Casuccio, A., Relationship between background cancer pain, breakthrough pain, and analgesic treatment: A preliminary study for a better interpretation of epidemiological and clinical studies (2013) Curr. Med. Res. Opin., 29, pp. 667-671; Davies, A., Zeppetella, G., Andersen, S., Damkier, A., Vejlgaard, T., Nauck, F., Radbruch, L., Buchanan, A., Multi-centre European study of breakthrough cancer pain: Characteristics and patient perceptions of current and potential management strategies (2011) Eur. J. Pain, 15, pp. 756-763; Mercadante, S., Lazzari, M., Reale, C., Cuomo, A., Fusco, F., Marchetti, P., Mediati, R.D., Caraceni, A., Italian Oncological Pain Survey (IOPS): A multicentre Italian study of breakthrough pain performed in different settings (2015) Clin. J. Pain, 31, pp. 214-221; Mercadante, S., Adile, C., Torta, R., Varetto, A., Fulfaro, F., Giarratano, A., Casuccio, A., Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients (2013) Curr. Med. Res. Opin., 29, pp. 93-97; Mercadante, S., Costanzo, B.V., Fusco, F., Buttà, V., Vitrano, V., Casuccio, A., Breakthrough pain in advanced cancer patients followed at home: A longitudinal study (2009) J. Pain Symptom Manag., 38, pp. 554-560; Mercadante, S., Zagonel, V., Breda, E., Arcara, C., Gebbia, V., Porzio, G., Aielli, F., Narducci, F., Breakthrough pain in oncology: A longitudinal study (2010) J. Pain Symptom Manag., 40, pp. 183-190; Mercadante, S., Marchetti, P., Cuomo, A., Caraceni, A., Mediati, R.D., Mammucari, M., Natoli, S., Airoldi, M., Breakthrough cancer pain: Preliminary data of the Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS) (2017) Adv. Ther., 34, pp. 120-135; Davies, A., Buchanan, A., Zeppetella, G., Porta-Sales, J., Likar, R., Weismayr, W., Slama, O., Poulain, P., Breakthrough cancer pain: An observational study of 1000 European oncology patients (2013) J. Pain Symptom Manag., 46, pp. 619-628; (1979) WHO Handbook for Reporting Results of Cancer Treatment, pp. 15-22. , WHO: Geneva, Switzerland; Narayana, A., Katz, N., Shillington, A.C., Stephenson, J.J., Harshaw, Q., Frye, C.B., Portenoy, R.K., National Breakthrough Pain Study: Prevalence, characteristics, and associations with health outcomes (2015) Pain, 156, pp. 252-259; Caraceni, A., Martini, C., Zecca, E., Portenoy, R.K., Ashby, M.A., Hawson, G., Jackson, K.A., Pisasale, M., Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey (2004) Palliat. Med., 18, pp. 177-183; Hjermstad, M.J., Kaasa, S., Caraceni, A., Loge, J.H., Pedersen, T., Haugen, D.F., Aass, N., European Palliative Care Research Collaborative (EPCRC). Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (2016) BMJ Support Palliat. 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PY - 2018

Y1 - 2018

N2 - Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

AB - Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

KW - Breakthrough pain

KW - Cancer

KW - Palliative care

KW - Supportive care

KW - analgesic agent

KW - antiinflammatory agent

KW - buprenorphine

KW - codeine

KW - fentanyl

KW - hydromorphone

KW - methadone

KW - morphine

KW - naloxone plus oxycodone

KW - opiate

KW - oxycodone

KW - paracetamol

KW - tapentadol

KW - tramadol

KW - adult

KW - aged

KW - analgesia

KW - Article

KW - breakthrough pain

KW - cancer diagnosis

KW - cancer patient

KW - clinical feature

KW - confusion

KW - constipation

KW - daily life activity

KW - female

KW - head and neck cancer

KW - headache

KW - human

KW - Karnofsky Performance Status

KW - major clinical study

KW - male

KW - metastasis

KW - multicenter study

KW - nausea

KW - neuropathic pain

KW - pain intensity

KW - unspecified side effect

KW - vomiting

U2 - 10.3390/cancers10060175

DO - 10.3390/cancers10060175

M3 - Article

VL - 10

JO - Cancers

JF - Cancers

SN - 2072-6694

IS - 6

ER -