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Breakthrough cancer pain (BTcP) management: a review of international and national guidelines
  1. Andrew Neil Davies1,
  2. Frank Elsner2,
  3. Marilène Jeanne Filbet3,
  4. Josep Porta-Sales4,
  5. Carla Ripamonti5,
  6. Daniele Santini6 and
  7. Kath Webber1
  1. 1 Department of Supportive and Palliative Care, Royal Surrey County Hospital, Guildford, UK
  2. 2 Department of Palliative Medicine, Uniklinik RWTH Aachen University, Aachen, Germany
  3. 3 Département de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Pierre-Bénite, France
  4. 4 Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
  5. 5 Supportive Care in Cancer Unit, Istituto Nazionale dei Tumori, Milan, Italy
  6. 6 Department of Medical Oncology, Università ’Campus Bio-Medico di Roma', Rome, Italy
  1. Correspondence to Dr Andrew Neil Davies, Department of Supportive and Palliative Care, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK; adavies12{at}nhs.net

Abstract

Objective Breakthrough cancer pain (BTcP) is common and has a significant impact on the quality of life of patients with cancer. This review compares current national/international BTcP guidelines in order to identify disparities and priorities for further research.

Methods Relevant guidelines were identified using searches of PubMed, the National Guideline Clearinghouse, the internet (commercial search engines), and correspondence with key opinion leaders and relevant pharmaceutical companies. Identified guidelines were compared, using the Association for Palliative Medicine of Great Britain and Ireland recommendations as the ‘reference’ guideline.

Results Ten specific BTcP guidelines were identified/reviewed, as well as major international generic cancer pain guidelines. In general, there was good agreement between the specific BTcP guidelines, although there remain some differences in terms of definition, diagnostic criteria and treatment of BTcP. Disparities between the different BTcP guidelines invariably reflect personal opinion rather than research evidence. Generic cancer pain guidelines continue to support the use of oral opioids as rescue medication, while specific BTcP guidelines invariably endorse the use of transmucosal opioids as rescue medication.

Conclusion Current guidelines agree on many aspects of the management of BTcP. However, the evidence to support current guidelines remains low grade, and so more research is needed in this area of care. Moreover, there needs to be an international consensus on the definition and diagnosis criteria of BTcP.

  • breakthrough pain
  • cancer pain
  • guideline

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Footnotes

  • Contributors AND conceived the idea for the paper and wrote the final draft of the paper. All of the authors were involved in reviewing the published guidelines, and all of the authors were involved in editing the various drafts of the paper.

  • Funding TEVA Pharmaceuticals Europe BV provided funding for the medical writer.

  • Competing interests AND has received honoraria for speaking from Angelini, Menarini, ProStrakan, Takeda and TEVA; honoraria for attending advisory boards from Grunenthal, MEDA, Nycomed, ProStrakan and TEVA; and unrestricted research grants from Cephalon, ProStrakan and Takeda. FE has received honoraria for speaking from Grunenthal and TEVA; and honoraria for attending advisory boards from Grunenthal, MEDA, Nycomed, ProStrakan and TEVA. MJF has received honoraria for attending advisory boards from MEDA, Takeda and TEVA. JPS has received honoraria for speaking from TEVA; honoraria for attending advisory boards from TEVA; and support for publication from Takeda. CR has received honoraria for speaking from Angelini and TEVA; and support for publication from Molteni.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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