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

Abstract

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 Yagüe81Radiation Oncology Department, Consorcio Hospital Provincial de Castellón, Castellón, Spain; 2Pain Unit, Consorcio Hospital Provincial de Castellón, Castellón, Spain; 3Pain Unit, Hospital General Universitario de Valencia, Valencia, Spain; 4Pain Unit, Hospital Universitario Infanta Sofía, Madrid, Spain; 5Pain Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Pontevedra, Spain; 6Pain Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain; 7Pain Unit, Hospital Puerta del Mar, Cádiz, Spain; 8Medical Department, Kyowa Kirin Farmacéutica, S.L.U, Madrid, SpainPurpose: 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: breakthrough cancer pain, bone metastases, management, health-related quality of life, opioids, satisfaction

Keywords

• breakthrough cancer pain
• bone metastases
• management
• health-related quality of life
• opioids
• satisfaction