Breakthrough pain in advanced cancer patients followed at home: a longitudinalstudy.

The aim of this study was to longitudinally assess breakthrough pain (BP) inadvanced cancer patients who were admitted to home palliative care. One hundredand one consecutive patients who were admitted to one of the two home careprograms and were representative of the cancer population followed at home inItaly were included. Patients were excluded only if at admission they werecognitively impaired or too unwell to provide reliable answers to questionsregarding data collection. At admission (T(0)), and one month later (T(1)), data were recorded about the pharmacological treatment of background pain and itseffectiveness; the presence of BP and its intensity, duration, and number ofepisodes; the occurrence of BP induced by movement; spontaneous relief afterstopping activity and limitation of physical activity because of pain onmovement; the analgesic drugs prescribed for BP; and the effectiveness of BPmedication. After the initial assessment, patients received analgesics forbackground pain and BP, as well as symptomatic treatment usually provided athome, according to local policies and protocols. At T(0), 70.2% of patients were receiving analgesic drugs, and 52% of them had uncontrolled pain. BP was reportedby 49.2% of these patients and had a mean duration and number of episodes per dayof 35.1 minutes (+/-35.0) and 2.4 (+/-1.5), respectively. Of patients with BP,65.7% had pain on movement, which decreased spontaneously after stopping activityin 73.9%. Physical activity was strongly limited in 78.2% of these patients. Mostpatients did not have a BP medication prescription. At T(1), a larger number ofpatients were receiving analgesics (P<0.002), and the number of patients with BP medication significantly increased (P<0.001). The incidence of BP and pain onmovement decreased (33% and 38.5%, respectively). This longitudinal studysuggests that BP is a dynamic entity dependent on several factors, includinganalgesic treatment and the course of disease. This helps explain the differentincidences reported in previous studies performed in different settings andconditions.