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. 2019 Jul 12:12:2125-2135.
doi: 10.2147/JPR.S194881. eCollection 2019.

Real-life management of patients with breakthrough cancer pain caused by bone metastases in Spain

Carlos Ferrer Albiach  1 , Francisco Villegas Estévez  2 , Mª Dolores López Alarcón  3 , María de Madariaga  4 , Alfonso Carregal  5 , Javier Arranz  6 , José M Trinidad Martín-Arroyo  7 , Antonio Javier Jiménez López  8 , Almudena Sanz Yagüe  8
Affiliations

Real-life management of patients with breakthrough cancer pain caused by bone metastases in Spain

Carlos Ferrer Albiach et al. J Pain Res. .

Abstract

Purpose: We aimed to explore the characteristics, and real-life therapeutic management of patients with breakthrough cancer pain (BTcP) caused by bone metastases in Spain, and to evaluate physicians' opinion of and satisfaction with prescribed BTcP therapy. Participants and methods: For the purposes of this study, an ad-hoc questionnaire was developed consisting of two domains: a) organizational aspects and care standards; b) clinical and treatment variables of bone metastatic BTcP patients. In addition, physicians' satisfaction with their prescribed BTcP therapy was assessed. Specialists collected data from up to five patients receiving treatment for BTcP caused by bone metastasis, all patients gave their consent to participate prior to inclusion. Results: A total of 103 cancer pain specialists (radiation oncologists [38.8%], pain specialists [33.0%], and palliative care (PC) specialists [21.4%]) were polled, and data on 386 BTcP patients with bone metastatic disease were collected. Only 33% of the specialists had implemented specific protocols for BTcP management, and 19.4% had established referral protocols for this group of patients. Half of all participants (50.5%) address quality of life and quality of care in their patients; however, only 27.0% did so from the patient's perspective, as they should do. Most patients had multiple metastases and were prescribed rapid-onset fentanyl preparations (71.2%), followed by immediate-release morphine (9.3%) for the treatment of BTcP. Rapid-onset fentanyl was prescribed more often in PC units (79.0%) than in pain units (75.9%) and radiation oncology units (61.1%) (p<0.01). Furthermore, most physicians (71.8%) were satisfied with the BTcP therapy prescribed. Conclusions: Our results demonstrate the need for routine assessment of quality of life in patients with bone BTcP. These findings also underscore the necessity for a multidisciplinary therapeutic strategy for breakthrough pain in clinical practice in Spain.

Keywords: bone metastases; breakthrough cancer pain; health-related quality of life; management; opioids; satisfaction.

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Conflict of interest statement

CFA and FVE received fees from Kyowa Kirin Farmacéutica, S.L.U., for the design, execution, and coordination of the study. In addition, the following authors declare potential conflicts of interest for individual activities for the industry outside the submitted work: CFA has received payments for consultancies and lecture fees from Astellas Pharma, Janssen, GP-Pharm, and Kyowa Kirin Farmacéutica, S.L.U. FVE has received payments for consultancies and lecture fees from Grünenthal, Gebro Pharma, Menarini, Takeda, Mylan, Esteve, and Ferrer. MDLA has received payments for consultancies and lecture fees from Kyowa Kirin Farmacéutica, S.L.U., Takeda, Gebro Pharma, Esteve, Teva, and Grünenthal. MM has received lecture fees from Kyowa Kirin Farmacéutica, S.L.U., Grünenthal, Mundipharma, Ferrer, and Medtronic. AC has received payments for consultancies and lecture fees from Takeda, Gebro Pharma, Esteve, Teva, Grünenthal, and Kyowa Kirin Farmacéutica, S.L.U. JA has received payments for consultancies and lecture fees from Esteve, Abstral and Kyowa Kirin Farmacéutica, S.L.U. JMTMA has received payments for consultancies and lecture fees from Grünenthal, Boston Scientific, Gebro Pharma, Angellini Farmaceutica, Takeda, Kyowa Kirin Farmacéutica, S.L.U. and Ferrer. AJJL and ASY are employed by Kyowa Kirin Farmacéutica, S.L.U. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Physician grade of recommendation for BTcP therapeutic. Notes: Physician grade of recommendation for BTcP therapeutic options was assessed using a 7-point Likert scale (where 1= least recommended and 7= most recommended). Abbreviation: BTcP, breakthrough cancer pain.
Figure 2
Figure 2
Distribution of patients according to type of BTcP treatment. Abbreviations: BTcP, breakthrough cancer pain; NSAIDS, nonsteroidal anti-inflammatory drugs.
Figure 3
Figure 3
Distribution of patients according to type of BTcP treatment and care units. Abbreviations: BTcP, breakthrough cancer pain; NSAIDS, nonsteroidal anti-inflammatory drugs; PC, palliative care; PU, pain units; RO, radiation oncology.
Figure 4
Figure 4
Distribution of physicians according to degree of satisfaction with BTcP therapy. Notes: Physician satisfaction with treatment was assessed using a 7-point Likert scale (where 1= extremely dissatisfied and 7= extremely satisfied). Abbreviation: BTcP, breakthrough cancer pain.
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