Supportive Care in Cancer

, Volume 22, Issue 6, pp 1655–1662 | Cite as

The use of Instanyl® in the treatment of breakthrough pain in cancer patients: a 3-month observational, prospective, cohort study

  • Ulf E. KongsgaardEmail author
  • Martin Eeg
  • Hanna Greisen
Original Article



Instanyl® (intranasal fentanyl spray) is a novel treatment for breakthrough pain (BTP) in cancer patients. It has shown a rapid onset of pain relief in clinical trials. This study examines the use of Instanyl® in real-life settings.


A 3-month observational, prospective, cohort study of cancer patients with BTP receiving Instanyl® (50, 100, or 200 μg) under routine clinical practice. Data were collected at three time points corresponding with routine clinic visits – baseline, Week 4, and Week 13. Primary outcomes: success of titration and maintenance dose after titration. Secondary outcomes: change in maintenance dose of Instanyl® and level of background pain medication; Brief Pain Inventory—Short Form (BPI-SF) and Patient Treatment Satisfaction Scale (PTSS) scores; adverse drug reactions (ADRs).


Titration with Instanyl® was successful in 84.5 % of 309 patients; most patients were titrated at the lowest dose (50 μg). The majority showed no change in maintenance dose, with little change in the level of background pain medication. BPI-SF and PTSS scores significantly improved from baseline to Week 4. The main reason for terminating Instanyl® was death, as expected due to the underlying disease; incidence of ADRs was low and no fatal ADRs were reported.


In a real-life group of cancer patients with disease progression, Instanyl® was titrated successfully at doses <200 μg in the majority of patients, requiring only one dose, with no further change in maintenance dose. Pain severity, impact of pain on daily life, and treatment satisfaction significantly improved with Instanyl® treatment. No unexpected ADRs occurred.


Cancer Breakthrough pain Fentanyl Instanyl Intranasal Observational 



The authors thank the investigators involved in the study. Assistance with preparing the manuscript was provided by Cambridge Medical Communication Ltd., funded by the study Sponsor, Takeda.

Conflict of interest

U. Kongsgaard has received honoraria from Takeda. M. Eeg and H. Greisen are employees of Takeda. The authors have full control of all primary data, and have agreed to allow the journal to review these data if requested.


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Copyright information

© The Author(s) 2014

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Authors and Affiliations

  • Ulf E. Kongsgaard
    • 1
    • 3
    Email author
  • Martin Eeg
    • 2
  • Hanna Greisen
    • 2
  1. 1.Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Medical FacultyUniversity of OsloOsloNorway
  2. 2.Takeda Pharma A/SRoskildeDenmark
  3. 3.Department of Anaesthesiology, The Norwegian Radium HospitalOslo University HospitalMontebelloNorway

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