Patients’ Satisfaction with Breakthrough Cancer Pain Therapy: A Secondary Analysis of IOPS-MS Study

Marco Mazzotta,1 Marco Filetti,2 Marta Piras,2 Sebastiano Mercadante,3 Paolo Marchetti,2,4 Raffaele Giusti5 1Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, Viterbo, Italy; 2Department of Clinical and Molecular Medicine, Oncology Unit, “La Sapienza” University of Rome, Azienda Ospedaliera Sant’Andrea, Rome, Italy; 3Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena, Palermo, Italy; 4Medical Oncology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; 5Medical Oncology Unit, Sant’Andrea Hospital of Rome, Rome, ItalyCorrespondence: Raffaele Giusti, Medical Oncology Unit, Sant’Andrea Hospital of Rome, via di Grottarossa, 1035/1039, Rome, 00189, Italy, Email raffaelegiusti@yahoo.itBackground: Cancer pain is one of the most important symptoms for patients. Pharmacological control is central for clinical management and to ensure well-being. In cancer patients, the management of breakthrough cancer pain (BTcP) is also crucial. This study aims to identify factors that can predict patients’ satisfaction with pain relief for BTcP.Methods: This was a secondary analysis of the IOPS-MS study, a large, observational, multicenter, national study where thirty-two Italian centers were involved to explore BTcP management. Clinical and pathologic features were recorded, as well as the patients’ degree of satisfaction with BTcP medications classified as dissatisfied (not or indifferent satisfied) versus satisfied (or very satisfied). Frequency distributions and the chi-squared test of independence were performed. A multivariate model was carried out by selecting significant variables upon univariate analysis using logistic regression.Results: From the original 4016 patients enrolled, 3840 were available for the study purpose. Seventy-one per cent of patients declared satisfaction with BTcP medications. Young age [odds ratio (OR) 1.29 (95% confidence interval, CI: 1.12– 1.50)], non-metastatic cancer stage [OR 1.53 (95% CI: 1.22– 1.91)], high Karnofsky performance status [OR 1.63 (95% CI:1.33– 1.99)], the absence of anticancer treatment [OR 1.42 (95% CI: 1.19– 1.69)], the NSAIDs/paracetamol use for background pain [OR 1.56 (95% CI: 1.34– 1.82)] and a high BTcP interference in activities of daily living [OR 2.34 (95% CI: 1.81– 3.01)] resulted positively correlated with dissatisfaction in the multivariate analyses. Also, the setting of care was related to difference in BTcP therapy satisfaction.Conclusion: This study proposes several key points to be considered in the pharmacological management of BTcP, useful to ensure patients’ satisfaction and optimal quality of life.Keywords: breakthrough cancer pain, opioids, pain control, patient satisfaction, quality of life