Impact of breakthrough pain on community-dwelling cancer patients: results from the National Breakthrough Pain Study

ABSTRACT

Objective: To characterize cancer-related breakthrough pain (BTcP) among community-dwelling patients with cancer.

Methods: Data from the National Breakthrough Pain Study, a cross-sectional observational survey describing breakthrough pain (BTP) in the community, were analyzed for a subset of patients with BTcP. Eligible patients were community-dwelling adults with commercial insurance and insurance claims consistent with cancer and chronic pain who consented to a structured telephone interview. Assessments included the Brief Pain Inventory–Short Form (BPI), the Short Form 12 Health Survey, the Sheehan Disability Scale, the Work Performance Questionnaire, Generalized Anxiety Disorder-7 Screener, and Patient Health Questionnaire-2.

Results: In total, 112 patients with cancer pain also experienced BTcP; 83.3% were in remission. Most patients reported experiencing ≥2 BTcP episodes per day, a median time to BTcP peak of 15 minutes, and a median duration of BTcP of 30 minutes. Mild pain at onset that gradually worsened was reported by 54.5% of patients, and incidental pain triggered by physical activity was reported by 58.0%. Most patients who reported using a medication to manage BTcP received an oral immediate-release opioid, such as oxycodone or hydrocodone, and only 1 received a rapid-onset opioid; few (24.1%) reported that pharmacologic treatment for BTcP worked every time. Patients reported mean (standard deviation) BPI scores of 4.2 (1.75) and 5.7 (1.98) for average and worst pain intensity during the preceding 24 hours, respectively, and high interference with activity, mood, ability to walk and work, social relations, sleep, and enjoyment of life.

Conclusion: Results indicate that BTcP among community-dwelling patients with cancer continues to be a health burden and reveals opportunities to improve its management.

KEYWORDS:

• Breakthrough pain
• cancer
• opioids
• patient-reported outcomes
• quality of life
• survey

Acknowledgments

The authors would also like to thank the participants who completed the telephone surveys.

Declaration of interest

This study was sponsored by Cephalon, Inc., now a wholly owned subsidiary of Teva Branded Pharmaceutical Products R & D, Inc. Writing support was provided by Bina J. Patel, PharmD, CMPP, of Peloton Advantage, LLC, funded by Teva Branded Pharmaceutical Products R & D, Inc. NP Katz consults, advises and conducts research for Teva Pharmaceuticals Inc. KL Gajria is an employee of Teva Pharmaceuticals Inc., and owns Teva stock options. AC Shillington and Q Harshaw are employees of EPI-Q, Inc., a research company contracted to develop, manage, and perform statistical analysis for this research study. JJ Stephenson is an employee of HealthCore Inc., a research company contracted to develop and manage this research study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This study was sponsored by Cephalon, Inc., now a wholly owned subsidiary of Teva Branded Pharmaceutical Products R & D, Inc. Teva provided a full review of the article.