Management of breakthrough cancer pain (BTcP) in patients with bone metastases of solid tumors

Abstract

8 ASL Latina, University of Rome "Sapienza", Latina Background: Bone metastases are frequent in patients with different type of tumors: the most common are prostate cancer, lung cancer, and breast cancer.The cause of pain could be related to direct tissue injury or other processes, such as inflammation [2, 12]. Breakthrough Cancer Pain requires an on-demand opioid in addition to the baseline opioid therapy and usually occurs in patients with advanced cancer and/or bone metastases. Recently, buccal or nasal fentanyls have been strongly recommended for breakthrough cancer pain episodes, especially in patients with bone metastases. In fact, while the older opioids (e.g., morphine solution) need 30-45 min for pain relief, rapid-onset fentanyl provides a sufficient analgesia in 10-15 min. [47]. Materials and methods: In our experience, conducted in Oncological Unit in Aprilia (LT), we retrospectively observed 40 patients with solid tumors and bone metastases with referred BTcP. All these patients were analyzed for pain management according to different fentanyl formulation (e.g. buccal tablet, nasal spray or lollipop). Results: Twenty patients (50%) had bone metastases from breast cancer, 10 patients (25%) from prostate cancer and 10 patients (25%) with metastatic lung cancer. All patients were treated for chronic pain with opioid therapy, in particular, 15% with oral morphine, 30 % with oxycodone and naloxone association and 55% with transdermal fentanyl. The patients were observed for 6 months consecutively with monthly control and telephone interview when required. All the BTcP episodes were registered. The pain relief duration was evaluated according to fentanyl formulation. We observed a good control in terms of both pain relief onset and duration of the effect, comparable among all formulations. Conclusions: Despite the small number of enrolled patients, our observational study showed an effectiveness of all transmucosal fentanyl used for BTcP relief. In light of these preliminary results, considering the large number of BTcP patients and the lack of available head-to-head comparisons for the different fentanyl formulations, we highlight the need for wider randomized trials to guide the best therapy for this subset of patients.