European Patient Survey Illuminates Life with Breakthrough Cancer Pain

September 9, 2009

Study results indicate that patients are having an average of three pain episodes per day, but a typical medication does not take effect until halfway through an episode.

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

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.

  • On average each patient had 3 episodes of BTCP per day
  • Each episode had an average duration of 60 minutes
  • 96% of the pain episodes were described as moderate to severe
  • For 87% 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 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:

  • 98% of patients were using orally administered drugs
  • The time to first noticing a reduction in pain was on average 20 minutes
  • The time to knowing that the pain medication was really making a difference was on average 30 minutes or half way through the typical BTCP episode observed in this survey

"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,” said Dr. Davies. “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.”

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.

Source: Nycomed