Majority of Patients with Cancer Experience Severe—and Undiagnosed—Breakthrough Pain
Lidia Schapira, MD, of Harvard Medical School and Massachusetts General Hospital, Boston, MA, and colleagues conducted a web-based survey to understand the effect of breakthrough cancer pain on quality-of-life as well as to “identify opportunities for improving outcomes through better assessment and communication.”
Patients being actively treated for cancer and survivors 18 years of age and older who had experienced cancer pain were invited via email, social media, and newsletter advertisements by 5 US-based cancer support organizations to participate in the online survey, which was conducted January to April 2012.
A total of 429 patients responded to the survey, 147 of whom were in treatment and 282 survivors. Mean age was 50 to 54 years and 81% were women. The most common types of cancer were breast (46%), head/neck (20%), and thyroid (14%).
Prevalence of breakthrough cancer pain was reported by 383 of 429 patients (89%), with 84% experiencing such pain a few times per week and 78% rating their worst pain as 7 (0=no pain; 10=worst possible pain).
Only 22% indicated a healthcare-provider had diagnosed breakthrough cancer pain, and 45% had such pain for more than 1 year before it was diagnosed.
“Patient-provider communication was not optimal: 26% of 429 patients reported their oncologist did not ask about pain, and 24% refrained from discussing pain until they couldn't take it anymore,” the investigators noted; 27% (104/383) reported holding back from discussing breakthrough cancer pain due to belief that pain is an unavoidable aspect of cancer. Of 275 respondents taking medication for breakthrough cancer pain, 40% indicated it took more than 30 minutes to work.
“Participants reported specific barriers to communicating with the healthcare team about their pain, which can contribute to underdiagnosis and mismanagement,” they concluded. “Proactive, precise conversations are needed to ensure effective diagnosis and treatment of breakthrough cancer pain.
The International Symposium on Supportive Care in Cancer is sponsored by the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology.