Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP)

Clin Transl Oncol. 2019 Mar;21(3):380-390. doi: 10.1007/s12094-018-1925-1. Epub 2018 Aug 9.

Abstract

Aims: To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception.

Design: Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled.

Participants and study period: A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016).

Results: The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain.

Conclusions: Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.

Keywords: Breakthrough cancer pain (BTcP); Clinical inertia; Prevalence of BTcP.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Breakthrough Pain / diagnosis*
  • Breakthrough Pain / epidemiology*
  • Cancer Pain / diagnosis*
  • Cancer Pain / epidemiology*
  • Cancer Pain / therapy
  • Female
  • Humans
  • Male
  • Medical Oncology / statistics & numerical data*
  • Middle Aged
  • Prevalence
  • Surveys and Questionnaires