Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study

J Boceta, A De la Torre, D Samper, M Farto, R Sánchez-de la Rosa, J Boceta, A De la Torre, D Samper, M Farto, R Sánchez-de la Rosa

Abstract

Introduction: There is no unanimous consensus on the clinical features to define breakthrough cancer pain (BTcP). The current project aimed to investigate the opinion of a panel of experts on cancer pain on how to define, diagnose, assess, treat and monitor BTcP.

Materials and methods: A two-round Spanish multi-centre exploratory Delphi study was conducted with medical experts (n = 90) previously selected from Medical Oncology Services, Radiation Oncology, Palliative Care/Home Care Teams, and Pain Units. The study intended to seek experts' consensus and to define a set of recommendations for the management of BTcP.

Results: It was generally agreed that, definition of BTcP implies that baseline pain should be controlled (84 %), although not necessarily with opioids (only 30 %); there must be exacerbations (98.9 %); the duration of each episode should last <1 h (70 %); the intensity of pain ≥7 out of 10 (67.8 %); and the number of flares per day should not be less than four. All participants supported the use of the Davies algorithm for the diagnosis. The use of a 'Patient Diary' was highly recommended. The optimal treatment should have a rapid onset, a short-acting analgesic effect (1-2 h) and transmucosal nasal or oral administration. It was considered very important to develop protocols for the management of cancer pain.

Conclusions: The present Delphi study identified a set of recommendations to define, assess and monitor BTcP.

Keywords: Baseline cancer pain; Breakthrough cancer pain; Cancer; Consensus; Delphi; Management.

Conflict of interest statement

Dr. Jaime Boceta has received personal fees from Grunental, Esteve and Teva Pharma, and non-financial support from Grunental. Dr. Alejandro de la Torre has received personal fees from Astellas, Janssen, Protrakan, Angelini, Merck and Teva. Dr. Daniel Samper has received personal fees from Teva. Dr. Monica Farto reports to work in the medical department of TEVA. Dr. Rainel Sanchez-de la Rosa reports to work in the medical department of TEVA. Research involving human participants and/or animals This article does not contain any studies with human participants or animals performed by any of the authors. Funding This study was funded by TEVA Pharmaceutical Industries.

Figures

Fig. 1
Fig. 1
Participants (n = 90) responded to the question of the characteristics to be conveniently considered to define BTcP. Each topic was classified as ‘essential’, ‘non-essential’ and ‘must not be considered’. Results obtained from the two rounds of the Delphi study are expressed as a percentage (%)
Fig. 2
Fig. 2
Davies diagnostic algorithm
Fig. 3
Fig. 3
Participants (n = 90) respond to the questions about what information (items on the left edge) should be written down on the clinical history of the patient and the importance of each of these items (see the Likert score column). When indicated, data are shown as a percentage. Likert score ranged from 1 (strongly disagree) to 7 (strongly agree). *Statistical differences among the surveyed medical specialties were observed
Fig. 4
Fig. 4
Participants (n = 90) respond to the characteristics of the ideal treatment to manage BTcP (a) and the most recommended breakthrough analgesic drug (b). When indicated, data are shown as a percentage (a). The best medication (b) was scored using a Likert scale ranged from 1 (strongly disagree) to 7 (strongly agree). *Statistical difference among medical specialties (p = 0.0086)
Fig. 5
Fig. 5
Participants (n = 90) were asked to score the importance of several items to be registered for the titration of BTcP medication. Items were scored using a Likert scale ranged from 1 (unimportant) to 7 (extremely important). *Statically significant differences were observed among medical specialties
Fig. 6
Fig. 6
Participants (n = 90) responded about the time-frame for the first follow-up visit after initiating the treatment of BTcP. Possible responses were scored using a Likert scale ranged from 1 to 5 (1, in no case– 5, in all cases)

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