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Delphi Consensus on the Follow-up of Cancer Patients with Breakthrough Pain Under Opioid Treatment

  • Medicine
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Abstract

Background

Breakthrough cancer pain (BTcP) is one of the most common symptoms related to the disease and its treatment. Its management differs from that of chronic pain but there is not a wide consensus about fundamental aspects of BTcP definition, diagnosis, follow-up, and management. The objective of this study is to reach a consensus on the follow-up of patients with BTcP under opioid treatment.

Background

This work was conducted using a modified Delphi method organized in two rounds and involving a panel of 84 medical oncologists. A questionnaire of 66 items was developed with the following topics: (1) When to perform the first and subsequent BTcP treatment evaluations; (2) What to assess at the first follow-up visit and how; and (3) What to assess in the following visits and how.

Results

After two rounds, a consensus was reached in 53 of 66 items proposed (80.3%). The main agreements reached include: The first follow-up visit should preferably be face-to-face; increase the number of visits after detecting poor control of BTcP; assess pain control episodes of BTcP in the first and following visits; adjust treatment dose of opioids due to poor control of BTcP; and adopt measures to prevent aberrant opioid-induced behaviors when treating BTcP in patients with cancer.

Conclusion

This Delphi consensus highlights the different points of view of medical oncologists regarding the follow-up of patients with BTcP under opioids treatment. Nonetheless, the conclusions reached can facilitate optimizing monitoring of these patients and promote long-term effectiveness of BTcP control.

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Acknowledgments

The authors wish to thank the Research Unit at Luzán 5 (Madrid) for the design and coordination assistance; Fundación para la Excelencia y la Calidad de la Oncología (ECO) foundation as the project promoter; and Dr. Fernando Sánchez Barbero for the support on the preparation of this manuscript.

Funding

This study was funded by Kyowa Kirin Farmacéutica S.L.U., through the ECO Foundation.

Author information

Authors and Affiliations

  1. Servicio de Oncología Médica, Hospital Clínico San Carlos Departamento de Medicina, Universidad Complutense, Calle del Prof. Martín Lagos, s/n, 28040, Madrid, Spain

    José Luis Larriba González

  2. Servicio de Oncología Médica, Hospital de Manacor, Manacor, Mallorca, Spain

    Diego Cayuela López & Raquel Molina Villaverde

  3. Servicio de Oncología Médica, Complejo Hospitalario Universitario de Orense, Orense, Spain

    Ovidio Fernández Calvo

  4. Servicio de Oncología Médica, Hospital de Manises, Manises, Valencia, Spain

    Salvador Garcerá Juan

  5. Hospital Universitario Príncipe Asturias, Alcalá de Henares, Madrid, Spain

    Raquel Molina Villaverde

  6. Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain

    Juan José Reina Zoilo

  7. Fundación ECO, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain

    Vicente Guillém

  8. Fundación ECO, Servicio de Oncología Médica, Hospital General Universitario, Universidad de Valencia, Valencia, Spain

    Carlos Camps

  9. Fundación ECO, Servicio de Oncología Médica, Hospital Sanitas La Moraleja, Madrid, Spain

    Margarita Feyjóo

Authors
  1. José Luis Larriba González
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  2. Diego Cayuela López
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  3. Ovidio Fernández Calvo
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  4. Salvador Garcerá Juan
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  5. Raquel Molina Villaverde
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  6. Juan José Reina Zoilo
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  7. Vicente Guillém
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  8. Carlos Camps
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  9. Margarita Feyjóo
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Contributions

All authors were equally responsible for developing the Delphi survey, coordinating the study, interpreting the results, and revise and approve the final manuscript.

Corresponding author

Correspondence to José Luis Larriba González.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any study with human participants or animals performed by any of the authors. Anonymity of the panelists who completed the questionnaire was guaranteed. The study was approved by the Clinical Research Ethics Committee of the Hospital Clínico San Carlos (Madrid, Spain).

Informed Consent

Informed consent for this study is not necessary. Due to the Delphi methodology, which guarantees the anonymity of the panelists who completed the questionnaire, it was not necessary to obtain a consent report from them. No patients participated in the study.

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Larriba González, J.L., Cayuela López, D., Fernández Calvo, O. et al. Delphi Consensus on the Follow-up of Cancer Patients with Breakthrough Pain Under Opioid Treatment. SN Compr. Clin. Med. 1, 891–899 (2019). https://doi.org/10.1007/s42399-019-00125-x

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