Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients: results from the Cancer Pain Outcome Research Study Group

Clin J Pain. 2011 Jan;27(1):9-18. doi: 10.1097/AJP.0b013e3181edc250.


Objective: Breakthrough cancer pain (BTcP) is a frequent event in cancer patients, with a prevalence from 19% to 95%. The reasons for such variability are explained by several factors, including different definitions across studies. In the framework of a wider initiative, we have analyzed the epidemiology of BTcP and identified factors associated with the pattern of care.

Methods: This study reports the results from a multicenter, prospective, nonrandomized, longitudinal study carried out in Italy between 2006 and 2007 on patients with cancer and pain. Transient exacerbations of pain were assessed with 3 different questions, and 1 composite variable to operationally define BTcP was then used as main outcome. After univariate analysis, a logistic model was also fitted to identify prognostic and predictive factors.

Results: One hundred and ten centers recruited 1801 cases of which 40.3% had BTcP at baseline. Most patients did not receive rescue therapy at the time of study inclusion. Univariate analysis identified several associations with clinical variables. A strong association has been also found with the type of recruiting centers, with oncologic wards reporting a somewhat lower proportion of patients with BTcP (-30%) when compared with palliative centers. Patients with BTcP had a high probability of dying (OR=1.4, 95% CI: 1.1-1.7, P-value 0.006) and to change of the opioid with another for analgesic failure or for side effects (OR=1.4, 95% CI: 1.0-1.9, P-value 0.040)

Discussion: These findings confirm the high prevalence of BTcP and substantial undertreatment and identify a few factors associated with prevalence and prognosis.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Humans
  • Italy
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Pain / drug therapy*
  • Pain / epidemiology*
  • Pain / etiology
  • Pain Measurement
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome