The first results of the first European survey of cancer patients' experience of breakthrough pain were presented at the 6th congress of the European Federation of Chapters of the International Association for the Study of Pain (EFIC).

Previous surveys have looked at the overall management of pain in cancer patients but this is the first international study to look in detail at Breakthrough Cancer Pain (BTCP) from a patient perspective. These results for the first 200 patients from the UK, Sweden and Denmark offer valuable insight into cancer patients' experiences with breakthrough pain management and the impact of the condition on their daily lives.

The median number of BTCP episodes per patient per day was 3

Each episode had a median duration of 60 minutes

96% of the pain episodes were described as moderate to severe

For 90% of patients their BTCP interfered with their daily living including their ability to sleep, walk and get on with other people "The study documents that breakthrough pain has a significant impact on cancer patients' daily lives," explained Dr. Andrew Davies, Department of Palliative Medicine, Royal Marsden Hospital, UK and the principal investigator of this survey. "Breakthrough pain is very different to background pain. Background pain is a continuous, chronic pain requiring around-the-clock medication. Breakthrough pain is a fast onset, short duration, intense pain that breaks through the chronic pain even when this is being controlled with medication. It is incapacitating and very distressing to the patient."

For this kind of pain episode the ideal treatment would be fast acting with a short duration of action to most closely match the nature of BTCP episodes. Moreover, it must be easy to use to improve patient compliance. However, the results of the survey show that: At least 95% of patients were using orally administered drugs

The time to first noticing a reduction in pain had a median time of 20 minutes

In this survey the median time to peak effect of the current BTCP rescue medications was 30 minutes "Oral opioids are still commonly used to manage BTCP despite the fact that the way these drugs work does not match the characteristics of a BTCP episode. Opioids given by other routes, for example intranasal, have significant advantages over oral opioids and the interim results from this survey suggest that these routes would be suitable for and welcomed by the majority of cancer patients with breakthrough pain" said Dr. Andrew Davies.

The European Survey of Breakthrough Cancer Pain is continuing to recruit patients in Germany and Ireland and will expand into Austria, Belgium, Czech Republic, Finland, France, Greece, the Netherlands, Norway, Portugal, Spain and Switzerland to provide health care professionals across Europe with patient insights on the management of breakthrough cancer pain.

References
1. Davies A et al. European survey of oncology patient's experience of breakthrough cancer pain: UK, SE and DK results. Poster presented at EFIC 2009.

About the survey First phase of an ongoing, multicentre observational study

First five countries include: UK, Sweden, Denmark, Germany, Ireland

11 palliative care units

400 patients with breakthrough cancer pain

Data collected on breakthrough cancer pain and treatment of breakthrough cancer pain

First results are based on 200 patients from UK (80), Sweden (80) and Denmark (40)

The study is supported by an educational grant from Nycomed. Source:
Mette Thorn Sørensen
Cohn & Wolfe, Copenhagen