Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP)
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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.
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).
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.
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.
KeywordsBreakthrough cancer pain (BTcP) Clinical inertia Prevalence of BTcP
The Active study is a scientific initiative by the Foundation to further the Excellence and Quality of Oncology (ECO in Spanish) and the Francisco de Vitoria University in Madrid. The authors thank all of the medical oncologists who took part in the survey for their contribution to the study.
This study was funded by Kyowa Kirin Farmacéutica S.L.U., through the ECO Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was realized in agreement by the ethical requirements of the declaration of Helsinki, review of Scotland (October, 2000) for the investigation by human beings.
All persons gave their informed consent prior to their inclusion in the study.
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