1587P - How Spanish medical oncologists manage breakthrough pain? A national study

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Palliative Care
Supportive and Palliative Care
Presenter Enrique Aranda
Citation Annals of Oncology (2017) 28 (suppl_5): v543-v567. 10.1093/annonc/mdx388
Authors E. Aranda1, C. Camps Herrero2, P. Khosravi3, M. Feyjoo4, A. Anton Torres5, P. Gascon6, J. Garcia Foncillas7, E. Diaz Rubio8, V. Guillem Porta9, A. Carrato10, M. Constenla Figueiras11, J.J. Cruz Hernandez12, R. López13
  • 1Medical Oncology, University Hospital Reina Sofia, 14004 - Cordoba/ES
  • 2Medical Oncology, Hospital General Universitario Valencia, 46018 - Valencia/ES
  • 3Oncology Department, Hospital Universitario de Torrejón, 28850 - Torrejón de Ardoz/ES
  • 4Oncology Department, Hospital Sanitas La Moraleja, 28050 - Madrid/ES
  • 5Oncology, Hospital Miguel Servet, 50009 - Zaragoza/ES
  • 6Division Of Medical Oncology, Institut Clinic Malalties Hemato-Oncològiques (ICMHO), 08036 - Barcelona/ES
  • 7Cancer Institute, University Hospital "Fundacion Jimenez Diaz", 28040 - Madrid/ES
  • 8Medical Oncology, Hospital Clinico Universitario San Carlos. CIBERONC Instituto de Salud Carlos III, 28040 - Madrid/ES
  • 9Oncology, Fundación Instituto Valenciano de Oncología, 46009 - Valencia/ES
  • 10Medical Oncology, Hospital Universitario Ramon y Cajal, 28031 - Madrid/ES
  • 11Medical Oncology, Hospital Provincial de Pontevedra, 36001 - Pontevedra/ES
  • 12Oncología Médica, Hospital Universitario de Salamanca, 37007 - Salamanca/ES
  • 13Medical Oncology Department, Hospital Clínico de Santiago, Santiago de Compostela/ES



Many cancer patients experience transient exacerbations of severe pain, known as breakthroughcancer pain (BTcP), a complex pain state that negatively impacts patients’ quality of life. We evaluated the knowledge of BTcP management according to the Spanish Society of Medical Oncology (SEOM) clinical practice guideline.


Fundación ECO (Foundation for Excellence and Quality in Oncology) conducted a survey regarding knowledge of managing BTcP focusing on: awareness of SEOM guidelines, agreement with recommendations, and implementation in clinical practice.


A total of 83 oncologists responded: 65% were female, mean age was 40-year-old and mean time in practice was 13 years. Overall, 82% were aware of guidelines and the agreement with recommendations ranged from 99-100%. Regarding implementation, 87.6% declared full compliance, nonetheless adherence in clinical practice ranged from 30.1% to 86.7% for documentation of BTcP episodes in medical records, and 75.9% to 91.6% for therapeutic management.100% of oncologists agreed on the prescription of specific medication for BTcP and most of them (91.6%) that rapid onset fentanyl formulations should be considered the first line of treatment.rnTable:


CPG AWARENESS 81.93% (68/83)AGREEMENTIMPLEMENTATION (in medical records)IMPLEMENTATION (ranked drug of choice characteristics)
SEOM 97.1%100% documentationEpisodes (n) 73.5%Rapid onset
ESMO 63.2%99% best evidencePain intensity 66.3%High potency
NCCN 58.8%99% specific medicationDuration 45.8%Short duration
Instit 19.1%99% fentanyl 1st choiceTime to peak 30.1%Route of administration
Other 7.3%rnTriggers 75.9%Ease of use
rnrnRelief strategies 73.5%Minimum side effects
rnrnEtiopathogenia 86.7%rn


Our results support efforts and targeted education of medical oncologists in BTcP management. However, our study raises concerns about guidelines dissemination deficiencies as well as vague statements that underscore a need for more effective dissemination policy and more effective detailed recommendations.

Clinical trial identification

Legal entity responsible for the study

Fundación ECO (Foundation for Excellence and Quality in Oncology)


Kyowa Kirin Farmacéutica, S.L.U.


E. Aranda: Consulting or Advisory Role - Amgen; Bayer; Celgene; Merck Sharp & Dohme; Roche; Sanofi P. Gascon: Consulting or Advisory Role - Ability Pharma (Inst) Research Funding - Ability Pharma (Inst) E. Diaz Rubio: Consulting or advisory role or speaker bureau: Roche, Merck Serono, Amgen, Bayer, MSD, Genomica, Servier. A. Carrato: Consulting or Advisory Role - Amgen; Baxalta; Bayer; Bristol-Myers Squibb; Celgene; Merck; MSD Oncology; Roche; Sanofi Speakers\' Bureau - Amgen; Bayer; Celgene; Merck Travel, Accommodations, Expenses - Celgene; Merck; Roche All other authors have declared no conflicts of interest.