Clinical and Translational Oncology

, Volume 20, Issue 5, pp 613–618 | Cite as

Oncologist’s knowledge and implementation of guidelines for breakthrough cancer pain in Spain: CONOCE study

  • R. López LópezEmail author
  • C. Camps Herrero
  • P. Khosravi-Shahi
  • V. Guillem Porta
  • A. Carrato Mena
  • J. Garcia-Foncillas
  • J. J. Cruz Hernández
  • P. Gascón Vilaplana
  • A. Antón Torres
  • E. Diaz-Rubio
  • M. Feyjoo Saus
  • E. Aranda Aguilar
Research Article



Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP.


Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline.


A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines.


Despite oncologist’s clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.


Breakthrough pain Oncologists Practice guidelines Pain management Attitude of health personnel Clinical competence 



The authors acknowledge all the medical oncologists who answered the survey for their contribution to the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This study was funded by Kyowa Kirin Farmacéutica S. L.U. through Fundación ECO.

Ethical approval

This study was approved by the Hospital Universitario Reina Sofía de Córdoba Clinical Research Ethics Committee and conforms to the ethical norms and standards in the 1964 Declaration of Helsinki and its later amendments. The manuscript does not contain clinical studies or patient data.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  • R. López López
    • 1
    Email author
  • C. Camps Herrero
    • 2
  • P. Khosravi-Shahi
    • 3
  • V. Guillem Porta
    • 4
  • A. Carrato Mena
    • 5
  • J. Garcia-Foncillas
    • 6
  • J. J. Cruz Hernández
    • 7
  • P. Gascón Vilaplana
    • 8
  • A. Antón Torres
    • 9
  • E. Diaz-Rubio
    • 10
  • M. Feyjoo Saus
    • 11
  • E. Aranda Aguilar
    • 12
  1. 1.Comisión Permanente Fundación ECO, Servicio de Oncología MédicaComplejo Universitario de Santiago de CompostelaSantiago De CompostelaSpain
  2. 2.Comisión Permanente Fundación ECOHospital General Universitario de ValenciaValenciaSpain
  3. 3.Servicio de Oncología MédicaHospital Universitario de TorrejónMadridSpain
  4. 4.Comisión Permanente Fundación ECO, Servicio de Oncología MédicaFundación Instituto Valenciano de OncologíaValenciaSpain
  5. 5.Comisión Permanente Fundación ECO, Servicio de Oncología MédicaHospital Universitario Ramón y CajalMadridSpain
  6. 6.Patrono Fundación ECO, Servicio de Oncología MédicaHospital Universitario “Fundación Jiménez Díaz”MadridSpain
  7. 7.Comisión Científica Fundación ECO, Servicio de Oncología MédicaHospital Universitario de SalamancaSalamancaSpain
  8. 8.Comisión Científica Fundación ECO, Servicio de OncologíaFundació ClínicBarcelonaSpain
  9. 9.Comisión Científica Fundación ECO, Servicio de Oncología MédicaHospital Universitario Miguel ServetZaragozaSpain
  10. 10.Presidente Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario San CarlosMadridSpain
  11. 11.Servicio de Oncología MédicaMadridSpain
  12. 12.Comisión Permanente Fundación ECO, Maimonides Institute of Biomedical ResearchHospital Universitario Reina SofíaCórdobaSpain

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