Identification and management of breakthrough cancer pain remains a challenge

September 30, 2011

Today, the results from a European Survey of Oncology Nurse Breakthrough Cancer Pain Practices were presented for the first time at The European Multidisciplinary Cancer Congress in Stockholm. The survey was performed for the Breakthrough Cancer Pain Initiative, a European Oncology Nursing Society (EONS) working group.

Lack of pain assessment tool leads to sub-optimal treatment

The survey which collected 1,164 completed responses among nurses from 12 European countries is the first European survey to look at oncology nurse perception of breakthrough cancer pain and its management. Breakthrough cancer pain is short, often debilitating, episodes of intense pain that are experienced by many cancer patients, despite having their chronic background pain controlled with medication.

The survey shows that distinguishing a patient's breakthrough cancer pain as a separate symptom from their chronic background pain represents an area of challenge for nurses practicing in a cancer setting. In fact, a key finding of the survey was an unmet training need for the management of breakthrough cancer pain among nurses since the majority (57 %) reported that they had not received training on breakthrough cancer pain management. The proportion of nurses receiving training in breakthrough cancer pain management varied significantly between countries with 72 % of Finnish nurses receiving training whilst only 6 % of Greek nurses receiving training.

- The survey results clearly show that there is an enormous opportunity to improve the pain outcomes of cancer patients via education. As an example, nearly half of the respondents reported that they do not utilize a pain assessment tool to help them describe this type of pain with variation between countries. Taken together, the respondent's answers support that breakthrough cancer pain is under-recognised, may be treated inappropriately and is impactful on patient's daily lives. The identified education gap of breakthrough cancer pain and its management, combined with no formal consensus about optimal pain management among oncology nurses should be addressed, says Professor Tone Rustøen, Division of Emergencies and Critical Care, Oslo University Hospital, and member of the advisory group to the Breakthrough Cancer Pain Initiative.

When presenting the survey results, Tone Rustøen noted that the management of breakthrough cancer pain should be implemented as an integral part of nurse's cancer pain treatment training in order to improve patient pain outcomes and well-being.

Need for more knowledge on medication options

The survey revealed a number of areas for additional education and guidance to nurses that can result in modified practice patterns that may improve breakthrough cancer pain management. An important area is the understanding of medication options. In the survey, the majority (57 %) of the nurses reported that most of their patients receive medication for the treatment of breakthrough cancer pain. However, the suitability of these medications may be called into question in their healthcare setting. Nearly 40 % of the nurses say they are not aware that medication specifically designed for breakthrough cancer pain exists.

- Breakthrough cancer pain is a distinct problem and requires specific interventions, including rescue medications that have an appropriately fast onset of action. Unfortunately, many patients are being treated with medication that is better suited for management of persistent pain, and these patients are, therefore, not receiving the most appropriate treatment for their breakthrough cancer pain, says Dr. Andrew Davies, Department of Palliative Care, St. Luke's Cancer Centre, UK, and also a member of the advisory group to the Breakthrough Cancer Pain Initiative.

Oncology nurses request more knowledge

Also, most nurses (78 %) report that breakthrough cancer pain significantly impacts patients' lives and almost all (81 %) have found it difficult to control their patients' pain during the past month. This is further reflected in 36 % of the nurses not feeling confident in advising patients about breakthrough cancer pain management and in 77 % reporting a need for more information on breakthrough cancer pain.

New guidelines on their way

- A starting point to address unmet education need is consensus and guidance to nurses on the management of breakthrough cancer pain. In the absence of nurse-specific guidelines, the European Oncology Nursing Society (EONS) will develop guidelines which describe and explain breakthrough cancer pain as an independent phenomenon with its own clinical symptoms, says Executive Director Clair Watts, European Oncology Nursing Society and continues:

- The objective of the guidelines is to provide guidance on assessment, identification and treatment of breakthrough cancer pain, which will serve as a platform to implement nurse-specific training programs.

The EONS Breakthrough Cancer Pain guidelines were presented in conjunction with the survey at The European Multidisciplinary Cancer Congress.
> Breakthrough Cancer Pain Initiative

To learn more about the Breakthrough Cancer Pain Initiative and the European Survey of Oncology Nurse Breakthrough Cancer Pain Practices, please visit:

The initiative is supported with an educational grant by Nycomed International Management GmbH.

> About EONS

The European Oncology Nursing Society is a pan-European organisation founded in 1984 and registered as an independent charity. Its activities aim to promote a healthier future for people affected by cancer, ensuring that they will benefit from the care of well educated, perceptive and proficient cancer nurses. EONS represents the voice of more than 20,000 cancer nurses. For more information, please visit:

> Further contact details
Professor Tone Rustøen
Division of Emergencies and Critical Care, Oslo University Hospital, Norway
+47 22 11 95 30

Dr. Andrew Davies
Department of Palliative Care, St. Luke's Cancer Centre (Royal Surrey County Hospital), UK
+44 1483 464885

Dr. Clair Watts, Executive Director
European Oncology Nursing Society
+32 2 779 9923

Cohn & Wolfe

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