Pain management in cancer patients receiving radiotherapy: Gorvamur study, a prospective observational epidemiological study

Abstract

Objectives: To assess breakthrough pain management in patients at radiation oncology and its impact on pain control in these patients, as well as the tolerability of the analgesic treatments used and the satisfaction and impact on the quality of life of patients. Material and Methods: An epidemiological, observational, prospective, multicentre study carried out in patients diagnosed with cancer and with cancer pain treated with a 3rd step analgesic therapy who had begun radiotherapy treatment (RT) susceptible to modification by an oncologist, for pain control. Patients were recruited from 15 Radiation Oncology Services centres from the regions of Valencia and Murcia between May 2013 and December 2014. Patient data collected included: demographic data, basal cancer process characterization and baseline pain, and information on basal analgesic treatment and RT employed. Pain level was recorded at 1 and 3 months by assessing: the change in the dimension of Brief Pain Inventory (BPI) pain and the amount of pain caused by episodes of breakthrough pain, the level of satisfaction, the quality of life (EQ-5D), and the tolerability to analgesic treatment. Results: Patients included in the analysis (n = 49) were mainly males (72.3%) and the mean age (± Standard Deviation) was 63.7 ± 11.5 years. In 26.5% of patients the tumours were located in lungs and 28.6% in head and neck. All but one of the patients reported pain during the baseline visit (20.8% due to the primary tumour, 54.2% to metastases, and 22.9% to RT treatment). The median (Q1-Q3) number of breakthrough crises / day was 3.0 (2-4.5). Overall, 60.4% were receiving treatment for breakthrough pain and Fentanyl was the most commonly used drug (70.4%). Pain management strategies were: reinforcement / modification of long-term analgesics (30.4%), reinforcement / modification of short-term analgesics (21.7%), reinforcement / modification of long-term and short-term analgesics (21.7%), and decrease / suppression of any fast- or long-term analgesics (26.1%). Independently from the strategy, a decrease in the maximum pain and the total amount of pain were observed over time, and an improvement during the follow-up visits was observed in the quality of life, health gain, and overall treatment satisfaction. Only two adverse reactions were reported. Conclusions: Breakthrough pain in cancer patients, who underwent radiotherapy treatment, is a symptom of high prevalence. There is no predominant analgesic strategy in the management of these patients, but Fentanyl is the drug most frequently used. Patients are very satisfied with the pharmacologic treatment and the reduction in the breakthrough pain obtained has a favourable effect on the global health status and quality of life of patients.