European patient survey add weight to expert call for greater clinical consensus on BTCP

Further results from the European Survey of Breakthrough Cancer Pain¹ were presented for the first time today at the 6th Research Congress of the European Association for Palliative Care (EAPC) in Glasgow.

The survey, which is the first international survey to look in detail at breakthrough cancer pain (BTCP) from a patient perspective, show that up to 45% of cancer patients experiencing breakthrough pain do not adhere to medication despite suffering from devastating episodes.

“The low adherence to drug therapy is a remarkable discovery and demonstrates that current treatments aren’t adequately meeting patients’ needs during these incapacitating episodes of pain,” explained Dr. Andrew Davies, Department of Palliative Medicine, Royal Marsden Hospital, UK and the principal investigator of this survey.

The survey, moreover, found that up to 50% of patients seek additional help from non-pharmacological methods such as heat, positional changes and rest demonstrating the need for improved pain relief. When asked about the ideal BTCP medication, patients wanted (in order of ranking)

• A medication that relieves the pain completely
  
• A medication that relieves the pain quickly
  
• A medication that causes few side effects
  
• A medication that is easy to use
  
• A medication that can be given by a relative/carer

However, the results of the survey show that patients are not given a medication that matches these needs. 90% of patients were receiving oral opioids to manage their breakthrough pain. Studies have shown that the median interval from onset to peak intensity of the typical BTCP episode is only three minutes² and that the average episode lasts between 30-60 minutes^{3, 4}. The time to peak analgesic effect of oral opioids is documented to be approximately 60-90 minutes⁵, long after a majority of the episodes have ended.

“Breakthrough pain is a distinct problem, and requires specific interventions including rescue medications that have an appropriately fast onset of action. Unfortunately, many patients are being treated with medications that are more suited to the management of persistent pain, and so are not receiving the most appropriate treatment for their breakthrough pain.,” said Dr. Andrew Davies.

A systematic literature review conducted with the purpose of assessing and classifying cancer breakthrough pain on behalf of the European Palliative Care Research Collaborative (EPCRC)⁶ likewise concludes that variations in cancer pain intensity are highly prevalent, yet the phenomenon is not well understood.

“There is no widely accepted definition, classification system or well-validated assessment tool for cancer-related breakthrough pain, but there is strong concurrence on most of its key attributes. An internationally agreed upon definition and classification system for cancer-related breakthrough pain, and a standard approach on how to measure it is required in order to improve patient care and support research in this poor-prognosis cancer pain syndrome,” said co-author, Professor Stein Kaasa, Chair of the European Association for Palliative Care Research Network (EAPC RN), principal investigator of the European Palliative Care Research Collaborative (EPCRC) and chair of the European Palliative Care Research Centre (PRC).

More information:
References

Davies A et al. The Impact of Living with Breakthrough Cancer Pain - Results of a European Survey of Oncology Patients. Data presented at EAPC 2010.
Portenoy RK et al. Breakthrough pain characteristics and impact in patients with cancer pain. Pain. 1999;81:129-34.
Gómez-Batiste X et al. Breakthrough cancer pain: prevalence and characteristics in patients in Catalonia, Spain. J Pain Symptom Manage. 2002;24:45-52.
Davies A et al. European survey of oncology patients’ experience of breakthrough cancer pain: UK, SE and DK results. Poster presented at EFIC 2009.
Davies A et al. 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. European Journal of Pain 2009;13:331-338.
Haugen et al. Assessment and classification of cancer breakthrough pain: A systematic literature review. Pain. 2010;149;3:476-482.
Ferrell BR et al. Use of routine and breakthrough analgesia in home care. Oncology Nursing Forum, 1999; 26, 1655-61.
Davies A et al. 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. European Journal of Pain 2009; 13(4): 331-8.

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