Breakthrough cancer pain treatment in Spain: physicians’ perception of current opioids utilization and prescription

Abstract

Objectives: Multiple reasons for suboptimal treatment of breakthrough cancer pain (BTcP) have been reported in the literature. We aimed to ascertain the perception of physicians on the potential inappropriate use and prescription of rapid-onset opioids (ROOs) for breakthrough cancer pain (BTcP) and the causes thereof.

Methods: Observational study based on an online survey addressed to doctors from different specialties (radiation oncology, medical oncology, anesthesia, palliative care and general practitioners) with experience in the management of BTcP in the Spanish public health setting.

Results: A total of 114 eligible specialists mainly from radiation oncology (37.7%), medical oncology (24.6%) and pain units (18.4%) participated in the study. Most agreed on important aspects of BTcP management, such as their preference for ROOs or the need for early follow-up after treatment initiation. However, their answers revealed a lack of standardization of BTcP diagnosis. Half of respondents believed that their BTcP patients might misuse ROOs. Physicians polled believed that lack of training in pain management (71.9%) and inadequate BTcP diagnosis and evaluation (66.7%) were the greatest obstacles for prescribing opioids. Specialists also thought that they do not provide the necessary information to patients (51.8%) and caregivers (57.9%) to guarantee the correct use of these drugs.

Conclusions: These results are of utmost importance as they highlight the need to increase physicians’ awareness of BTcP and its management and the need to improve communication with patients and their caregivers. Our findings also indicate the need for future research on the possible misuse of opioids in BTcP patients and its causes.

Keywords:

• Breakthrough cancer pain
• opioids
• barriers
• misuse

Transparency

Declaration of funding

This work was supported by Mylan Pharmaceuticals. Mylan pharmaceuticals sponsored the creation and maintenance of the study’s on-line database but was not involved in data collection and analysis or the conclusions of the study.

Declaration of financial/other relationships

FVE, MDLA, AAB and LOG received fees from Mylan pharmaceuticals, S.L.U. for the design, execution, and coordination of the study. In addition, the following authors declare potential conflicts of interest for individual activities for the industry outside the submitted work: FVE has received payments for consultancies and lecture fees from Kyowa kirin, Grunenthal, Gebro Pharma and Ferrer. MDLA has received payments for consultancies and lecture fees from Kyowa kirin, Takeda, Gebro pharma, Lab Esteve, Teva and Grünenthal. LOG has received payments for consultancies and lecture fees from Teva pharma, Abbott, Nutricia, Persan, Grunenthal, Janssen and Astellas. JdC has received payments for consultancies and lecture fees from Teva pharma, Takeda and Kiowa Kirin. MLG and MMK are employed by Mylan pharmaceuticals, S.L.U. MS-C was contracted by Mylan pharmaceuticals, S.L.U. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FVE and MDLA conceived and designed the study. All authors were involved in the design of the questionnaire, interpretation of results and manuscript outline. Data analysis and preparation of the first manuscript draft were performed by Medical Statistic Consulting staff following the indications of the authors. All authors revised critically the manuscript for intellectual content and approved the final version. All authors agree to be accountable for all aspects of the work.

Acknowledgements

The authors thank María Luisa Orera Peña (Global Medical Affairs Gastroenterology) and Marta Rodríguez de Miguel (Medical Advisor) from Mylan for their assistance with the creation and maintenance of the project. The authors would also like to thank Lucía Perez-Carbonell and Laura Hidalgo at MSC (Valencia, Spain) for medical writing assistance. All authors revised the manuscript versions and approved the final draft.

Data availability statement

There is no data set online associated with this article. The corresponding author can be contacted for more information regarding data and results.