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Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON)

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Abstract

Objective

To ascertain the level of agreement and achieve a consensus among cancer pain specialists in Spain with regard to the optimal definition, diagnosis, and management of breakthrough cancer pain (BTcP).

Design

Two-round Delphi methodology survey (February–May 2013) using seven-point Likert scales (ranging from 1 “strongly disagree” to 7 “strongly agree”) was carried out. Mean scores >5 or <3 indicated, respectively, agreement or disagreement. Scores from 3 to 5 indicated no consensus.

Results

A total of 126 experienced specialists were surveyed. Response rates were 68 % in round 1 and 90 % in round 2. Agreement (mean Likert score) was strongest for the proposed BTcP definition (6.6), the use of oral (6.1), and intranasal (6.0) transmucosal fentanyl, the need for early assessment after BTcP treatment initiation, and the need to improve staff knowledge of BTcP. Broad agreement was also reached regarding the need to systematically screen all cancer patients for BTcP (5.9). Most respondents (82 %) considered strong opioids to be appropriate treatment. In contrast, no consensus was reached regarding strong opioid treatment for baseline pain as a prerequisite for BTcP diagnosis.

Conclusions

Consensus was strong for most treatment, and diagnostic aspects were evaluated in the study. However, several important issues remain unresolved, particularly whether the diagnostic criteria must include strong opioids for background pain. Nurses’ awareness and understanding of BTcP was considered insufficient, and more training is needed in this area. Overall, agreement among specialists was good, but more work is needed to better define the optimal diagnostic features and treatments for this condition.

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Acknowledgments

This research was supported by a research grant from Takeda. The authors express their gratitude to the participants for their strong support that made this study possible. Professionals consented to participate voluntarily without receiving any remuneration for completing the questionnaire. We also would like to thank Bradley Londres for his help in revising and improving the manuscript. We would like to thank Tamara Pozo for her assistance in process of review and submission of the manuscript.

Funding

The study was sponsored by Takeda Farmacéutica España.

Author information

Authors and Affiliations

  1. Palliative Care Service, Institut Català d’Oncologia (ICO), Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: End of Life Care, Institut Català d’Oncologia, Barcelona, Spain

    J. Porta-Sales

  2. Pain Clinic, Hospital Universitario de la Princesa, C/Diego de León 62, 28002, Madrid, Spain

    C. Pérez

  3. Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Y. Escobar

  4. Medical Manager Takeda, Madrid, Spain

    V. Martínez

Authors
  1. J. Porta-Sales
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  2. C. Pérez
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  3. Y. Escobar
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  4. V. Martínez
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Corresponding author

Correspondence to V. Martínez.

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Conflict of interest

Authors Josep Porta-Sales, Concepción Pérez, and Yolanda Escobar have received honoraria for consultancy work only for this study from Takeda Farmacéutica España. Author Vicente Martinez is employed by Takeda Farmacéutica España.

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Porta-Sales, J., Pérez, C., Escobar, Y. et al. Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON). Clin Transl Oncol 18, 945–954 (2016). https://doi.org/10.1007/s12094-015-1468-7

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  • DOI: https://doi.org/10.1007/s12094-015-1468-7

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