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An evaluation of the use of traditional opioids and immediate-release fentanyl in the management of breakthrough cancer pain in an integrated cancer network
  1. A. Nwosu1,
  2. K. Marley2,
  3. E. Sulaivany3,
  4. A. Dickman1 and
  5. C. Littlewood4
  1. 1Marie Curie Palliative Care Institute Liverpool (MCPCIL)
  2. 2Aintree University Hospitals NHS Foundation Trust, Liverpool
  3. 3St. Rocco's Hospice, Warrington
  4. 4St. Helens and Knowsley NHS Trust, Liverpool

Abstract

Introduction Breakthrough cancer pain (BTcP) is common and is associated with significant morbidity. Immediate release Fentanyl products are licensed for the management of BTcP; however, some practical concerns exist about their safety and routine use in clinical practice.

Aims and Methods To identify the multi-disciplinary team (MDT) experience in managing BTcP in relation to APM guidance. To identify the MDT experience of using immediate-acting Fentanyl products in the management of breakthrough cancer pain. To develop new regional guidelines to help health professionals manage breakthrough cancer pain. A literature review informed the development of two audit surveys which examined the health professional's experience of: (i) Managing a patient with BTcP. (ii) Using immediate-acting Fentanyl products. Electronic surveys were distributed to multidisciplinary members of four integrated cancer networks during August 2011.

Results Twenty-eight BTcP surveys and 29 Fentanyl products survey proformas were completed. BTcP was identified correctly in most instances (80.8% of individuals had their background cancer pain controlled). Oxynorm was the most popular short-acting opioid (32% of occasions); Abstral was the most popular immediate-release Fentanyl preparation across hospice, hospital and community settings. Most episodes of BTcP were relieved in 30 minutes (56%). Concerns about storage and disposal (45%), delay in accessing medicines (45%), prescribing issues (62%) and education of generalists (62%) were highlighted by respondents.

Conclusion Most episodes of BTcP were correctly identified and in 56% of cases resolved within 30 minutes of receiving analgesia. Concerns around prescribing of immediate-acting Fentanyl products and the education of generalists were highlighted.

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