In Spain 77% of the episodes of Breakthrough cancer pain (BTcP), a common condition for cancer patients, are not properly diagnosed or treated. The ECO Foundation (Excellence and Quality in Oncology) has promoted this study with the collaboration of Francisco de Vitoria University, to compare the real-life clinical practice with the previous perception of the oncologists of the management of BTcP and to determine if clinical inertia exists in the approach of the BTcP episodes.
Observational and descriptive study consisting in two phases: a) opinion poll (self-completed online) answered by Spanish oncologists, and b) BTcP episodes screening and assesment (performed by the oncologist surveyed) in patients with a prior or current history of cancer pain (5 patients per oncologist). A recent expert consensus (1) and Davies algorithm were used to evaluate the correct diagnosis and optimal management of BTcP. A total of 108 oncologists participated in the study and 540 patients were evaluated.
Although most oncologists (>80%) refer questioning their patients about the possibility of BTcP, only 34% of them do it systematically in their clinical practice. Most specialists believed that BTcP episodes were unlikely to go unnoticed in their consultations (62%). After evaluating real-life clinical practice, the overall prevalence of BTcP obtained was 91% (493/540). The doctors had previously detected the BTcP condition in 59% of patients (291/493), demonstrating that the under-diagnosis of BTcP exceeds 40%. In addition, 42% of patients with known BTcP were not able to control their episodes of pain and, despite the persistence, in 13% of them, no changes or adjustments had been made in the dose intensity or schedule.
The study confirms that there is a significant prevalence of BTcP and a notable inertia in the management of BTcP episodes, which seems to be poorly detected and treated in patients with cancer. Expanding the use of tools to diagnose BTcP, such as Davies algorithm, might be useful to improve the QoL of patients suffering pain.
Clinical trial identification
Legal entity responsible for the study
Kyowa Kirin Pharmaceutical.
All authors have declared no conflicts of interest.