Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts

Abstract

Carlos Camps Herrero,1 Antonio Antón Torres,2 Juan Jesús Cruz-Hernández,3 Alfredo Carrato,4 Manuel Constenla,5 Eduardo Díaz-Rubio,6 Margarita Feyjoo Saus,7 Jesus Garcia-Foncillas,8 Pere Gascón,9 Vicente Guillem101Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain; 2Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain; 3Jefe del Servicio de Oncología Médica, Hospital Universitario De Salamanca-IBSAL, Salamanca, Spain; 4Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain; 5Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; 6Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain; 7Jefe del Servicio de Oncología Médica, Hospital La Moraleja, Madrid, Spain; 8Jefe de Servicio de Oncología Médica, Hospital Universitario “Fundación Jiménez Díaz”, Madrid, Spain; 9Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; 10Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, SpainPurpose: There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients.Patients and methods: A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3.Results: In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl.Conclusion: These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.Keywords: breakthrough pain, rapid-onset opioids, fentanyl, medical oncology, pain management

Keywords

• Breakthrough pain
• rapid onset opioids
• fentanyl
• medical oncology
• pain management.