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Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients

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Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena, 90146 Palermo, Italy
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Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome, 00155 Rome, Italy
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Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, 80131 Naples, Italy
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Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute, IRCCS Foundation, 20133 Milan, Italy
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Palliative Care and Pain Therapy Unit, Careggi Hospital, 50139 Florence, Italy
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Primary Care Unit, ASL RM1, 00165 Rome, Italy
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Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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Second Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, 10126 Turin, Italy
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Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, 30035 Venice, Italy
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Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy
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Medical Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, 90127 Palermo, Italy
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Medical Oncology, A.O.R.N. Cardarelli, 80131 Naples, Italy
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Palliative Care Unit, SAMO ONLUS, 95131 Catania, Italy
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Palliative Care Unit, ASL AL, 15033 Casale Monferrato, Italy
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Palliative Care Unit, Department of Primary and Community Care, ASL 3 Genovese, 16125 Genoa, Italy
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Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, 20141 Milan, Italy
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Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, 80131 Naples, Italy
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Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, 24121 Bergamo, Italy
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Medical Oncology Unit, National Cancer Research Center “Giovanni Paolo II”, 70124 Bari, Italy
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Pain Therapy Unit, “A. Businco” Hospital, ASL 8, 09134 Cagliari, Italy
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Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L’Aquila, 67100 L’Aquila, Italy
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Medical Oncology Unit, S. Croce Hospital, 61032 Fano-Pesaro, Italy
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Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50139 Florence, Italy
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Department of Medicine and Surgery Sciences, University of Bologna, 40126 Bologna, Italy
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PainTherapy, S. Croce e Carle Hospital, 12100 Cuneo, Italy, [email protected]
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Pain Therapy ICS Maugeri, IRCCS Foundation 27100 Pavia, Italy
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Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy
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Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
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Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, 00152 Rome, Italy
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Pain Medicine Unit, S. Camillo-Forlanini Hospital, 00152 Rome, Italy
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Pain Relief, A.O. Dei Colli, Monaldi Hospital, 80131 Naples, Italy
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Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, 56126 Pisa, Italy
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Medical Oncology, Castelfranco Veneto Hospital, 31033Treviso, Italy
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Department of Palliative Care with Hospice and Pain therapy Unit, “G. Salvini” Hospital, Garbagnate Milanese, 20024 Milan, Italy
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Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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Palliative Care, FARO Foundation, 10133 Turin, Italy
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Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
Membership of the Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS) Study Group is provided in the Acknowledgments.
Cancers 2018, 10(6), 175; https://doi.org/10.3390/cancers10060175
Received: 24 April 2018 / Revised: 29 May 2018 / Accepted: 30 May 2018 / Published: 1 June 2018
Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. View Full-Text
Keywords: breakthrough pain; cancer; palliative care; supportive care breakthrough pain; cancer; palliative care; supportive care
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Mercadante, S.; Marchetti, P.; Cuomo, A.; Caraceni, A.; Mediati, R.D.; Vellucci, R.; Mammucari, M.; Natoli, S.; Lazzari, M.; Dauri, M.; Adile, C.; Airoldi, M.; Azzarello, G.; Bandera, M.; Blasi, L.; Cartenì, G.; Chiurazzi, B.; Costanzo, B.V.P.; Degiovanni, D.; Fusco, F.; Guardamagna, V.; Iaffaioli, V.; Liguori, S.; Palermo, L.; Mameli, S.; Masedu, F.; Mattioli, R.; Mazzei, T.; Melotti, R.M.; Menardo, V.; Miotti, D.; Moroso, S.; Pascoletti, G.; De Santis, S.; Orsetti, R.; Papa, A.; Ricci, S.; Scelzi, E.; Sofia, M.; Tonini, G.; Valle, A.; Aielli, F.; On behalf of the IOPS-MS Study Group. Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients. Cancers 2018, 10, 175.

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