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Breakthrough cancer pain (BTcP) and quality-of-life outcomes.

61 Background: Breakthrough cancer pain (BTcP) is frequent in patients with advance solid tumors and is always associated with worsening of the quality of life (QoL). There are few studies in the literature on the effect of BTcP treatment on QoL. The aim of this analysis was to provide a qualitative evaluation of the effect of BTcP therapies considering different fentanyl formulation(nasal spray, lollipop or buccal tablets) on the QoL of treated patients.


METHODS
In our study, we enrolled patients with different advanced solid cancer treated with active and/or palliative therapies. All patients included have a baseline analgesis therapy and showed frequent BTcP episodes during the day. The patients were evaluated with a simultaneous care control (medical oncologist, palliativist, psychologist and nurse) every week for four consecutively weeks after initiating treatment with BtcP medicaments. A questionary about BtcP and QoL evaluation (QoL-BTcP scale) was administered. It was also completed by an interview during periodic visit. The main parameters investigated were frequency of BTcP, cancer pain value (NRSscale), fentanyl formulation for BTcP (nasal spray, lollipop or buccal tablets), time of onset of cancer pain relief and adverse events correlated with use of BTcP medicaments. At each simultaneuous care evaluation the authors evaluated the impact of BTcP medicaments on psychologic aspects using a validated Anxiety, Depression and health status Scale integrated to QoL-BTcP questionary (QoL-BTcP scale).


RESULTS
A total of 35 patients with > 2 BTcP episodes/die were enrolled (50% from 2 to 4 episodes, 45% from 5 to 6 episodes and 5% for those patients with more than 6 episodes). QoL-BTcP scores showed significant improvement in the QoL in terms of depression and other psychologic aspects in the first two subgroups (from 2 to 6BTcP episodes). The QoL-BTcP scale was worse in more depressed patients and in those patients at the end of life.


CONCLUSIONS
QoL-BTcP scale is a reliable and valid instrument for measuring QoL correlated to efficacy and tolerability of BTcP drugs. Results provide some suggestions for the development of programs to evaluate QoL in patient with cancer pain and implement BTcP interventions among cancer survivors.