A Canadian online survey of oncology nurses’ perspectives on the management of breakthrough pain in cancer (BTPc)

Margaret I. Fitch, Alison McAndrew, Stephanie Burlein-Hall

Abstract


This paper explores Canadian oncology nurses’ perception of management of breakthrough pain in cancer (BTPc). An online questionnaire was distributed to 668 oncology nurses across Canada, and 201 participated. More nurses reported that patients used hydromorphone (99.5%), morphine (97.0%), codeine (88.1%), or oxycodone (88.1%) for BTPc, than fentanyl preparations (64.7%). Problems with opioid administration reported by nurses included failure to work quickly enough (35.7%), difficulty swallowing (16.6%), need for caregiver assistance (13.2%), mouth sores (12.6%) and dry mouth (11.5%). Although most nurses discussed BTPc management with their patients, the vast majority (72.2%) were not very satisfied with current treatment modalities. Effective dialogue with patients and access to educational resources/tools may help optimize therapy and enhance concordance with BTPc medications.

Key words: breakthrough cancer pain, nursing, pain management, Canadian


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References


Canadian Institute for Health Information (CIHI). (2010). Canada’s

nursing workforce grows 9% in five years. Retrieved from

http://www.cihi.ca/cihi-ext-portal/internet/en/document/

spending+and+health+workforce/workforce/nurses/

release_09dec2010

The Canadian Pain Society (CPS) and the Canadian Pain Coalition

(CPC) Call to Action: The need for a National Pain Strategy for

Canada (NPSC). (2011, December 15). CPS National Task Force

on Service Delivery (first draft), July 2010. Retrieved from http://

www.canadianpainsummit2012.ca/media/11445/final%20

nat%20pain%20strategy%20for%20can%20121511%20eng.pdf.

Presented in Ottawa on April 24, 2012 at the Canadian Pain

Summit.

Cancer Care Ontario (CCO). (2008). Cancer-related Pain Management:

A Report of Evidence-Based Recommendations to Guide Practice.

Evidence-Based Series #16-2. Report Date: March 17, 2008.

Retrieved from https://www.cancercare.on.ca/common/pages/

UserFile.aspx?files=44127

CANO/ACIO (2011). CANO/ACIO Position Statement on the Nursing

Care of Persons Living with Cancer Pain. Retrieved from

http://www.cano-acio.ca/~ASSETS/DOCUMENT/About%20Us/

CANO%20Position%20statement%20on%20Pain.pdf

Davies, A., Zeppetella, G., Andersen, S., Damkier, A., Vejlgaard, T.,

Nauck, F., … Buchanan, A. (2011). Multi-centre European study

of breakthrough cancer pain: pain characteristics and patient

perceptions of current and potential management strategies.

[Multicenter Study Research Support, Non-U.S. Gov’t]. Eur J Pain,

(7), 756–763. doi:10.1016/j.ejpain.2010.12.004

Davis, M.P. (2011). Fentanyl for breakthrough pain: A systematic

review. [Review]. Expert Rev Neurother, 11(8), 1197–1216.

doi:10.1586/ern.11.63

Dobrow, M.J., Orchard, M.C., Golden, B., Holowaty, E., Paszat, L.,

Brown, A.D., & Sullivan, T. (2008). Response audit of an Internet

survey of health care providers and administrators: Implications

for determination of response rates. [Research Support, Non-U.S.

Gov’t]. J Med Internet Res, 10(4), e30. doi:10.2196/jmir.1090

Donner, B., & Zenz, M. (1995). Transdermal fentanyl: A new step

on the therapeutic ladder. [Clinical Trial Multicenter Study].

Anticancer Drugs, 6 Suppl 3, 39–43.

Elcigil, A., Maltepe, H., Esrefgil, G., & Mutafoglu, K. (2011). Nurses’

perceived barriers to assessment and management of pain in a

university hospital. J Pediatr Hematol Oncol, 33(Suppl. 1), S33–

doi:10.1097/MPH.0b013e3182121bef

European Oncology Nursing Society (2011). Backgrounder:

European Survey of Oncology Nurse Breakthrough Cancer Pain

Practices. Retrieved from http://www.cancernurse.eu/research/

breakthroughcancerpain.html

European Oncology Nursing Society (EONS). (2012). Breakthrough

Cancer Pain Initiative. Retrieved from http://www.cancernurse.

eu/research/breakthroughcancerpain.html

Glare, P., Aggarwal, G., & Clark, K. (2004). Ongoing controversies

in the pharmacological management of cancer pain. [Review].

Intern Med J, 34(1–2), 45–49.

Green, E., Zwaal, C., Beals, C., Fitzgerald, B., Harle, I., Jones, J., …

Wiernikowski, J. (2010). Cancer-related pain management: A

report of evidence-based recommendations to guide practice.

[Research Support, Non-U.S. Gov’t]. Clin J Pain, 26(6), 449–462.

doi:10.1097/AJP.0b013e3181dacd62

Hanks, G.W., Conno, F., Cherny, N., Hanna, M., Kalso, E., McQuay,

H.J., … Ventafridda, V. (2001). Morphine and alternative

opioids in cancer pain: The EAPC recommendations. [Guideline

Practice Guideline]. Br J Cancer, 84(5), 587–593. doi:10.1054/

bjoc.2001.1680

Haugen, D.F., Hjermstad, M.J., Hagen, N., Caraceni, A., & Kaasa, S.

(2010). Assessment and classification of cancer breakthrough

pain: A systematic literature review. [Research Support, Non-

U.S. Gov’t Review]. Pain, 149(3), 476–482. doi:10.1016/j.

pain.2010.02.035

Jacobsen, R., Moldrup, C., & Christrup, L. (2008). Clinical rationale

for administering fentanyl to cancer pain patients: Two Delphi

surveys of pain management experts in Denmark. [Research

Support, Non-U.S. Gov’t]. J Opioid Manag, 4(6), 383–391.

Jacobsen, R., Moldrup, C., & Christrup, L. (2009). Danish pain

specialists’ rationales behind the choice of fentanyl transdermal

patches and oral transmucosal systems—a Delphi study.

[Research Support, Non-U.S. Gov’t]. Pain Med, 10(8), 1442–1451.

doi:10.1111/j.1526-4637.2009.00724.x

McCaffery M. (1968). Nursing practice theories related to cognition,

bodily pain, and man-environment interactions. Los Angeles:

UCLA Students Store.

Mercadante, S. (2011). Managing breakthrough pain. [Review].

Curr Pain Headache Rep, 15(4), 244–249. doi:10.1007/

s11916-011-0191-5

Mercadante, S., Radbruch, L., Caraceni, A., Cherny, N., Kaasa,

S., Nauck, F., … De Conno, F. (2002). Episodic (breakthrough)

pain: Consensus conference of an expert working group of

the European Association for Palliative Care. [Consensus

Development Conference Review]. Cancer, 94(3), 832–839.

Mercadante, S., Villari, P., & Casuccio, A. (2011). An Italian survey

on the attitudes in treating breakthrough cancer pain in

hospice. Support Care Cancer, 19(7), 979–983. doi:10.1007/

s00520-010-0919-5

Morere, J.F., Poulain, P., Filbet, M., Krakowski, I., Serrie, A., Delorme,

C., Ammar, D., Scotte, F., & Grange, V. (2011). A national

prospective survey of breakthrough cancer pain characteristics

and treatments in France 10 years after the preliminary study

(ASCO 2000). Journal of Clinical Oncology, 2011 ASCO Annual

Meeting Proceedings (Post-Meeting Edition) Vol 29(No 15, Suppl.).

(May 20 Supplement)), e19661.

Portenoy, R.K., & Hagen, N.A. (1990). Breakthrough pain: Definition,

prevalence and characteristics. [Research Support, Non-U.S.

Gov’t]. Pain, 41(3), 273–281.

Portenoy, R.K., Payne, D., & Jacobsen, P. (1999). Breakthrough pain:

Characteristics and impact in patients with cancer pain. Pain,

(1-2), 129–134.

World Health Organization. (1996). Cancer Pain Relief, 2nd edition.

WHO: Geneva.

Zeppetella, G. (2008). Opioids for cancer breakthrough pain: A pilot

study reporting patient assessment of time to meaningful pain

relief. J Pain Symptom Manage, 35(5), 563–567. doi:10.1016/j.

jpainsymman.2007.06.012

Zeppetella, G. (2011a). Breakthrough pain in cancer patients.

[Review]. Clin Oncol (R Coll Radiol), 23(6), 393–398. doi:10.1016/j.

clon.2010.12.002

Zeppetella, G. (2011b). Opioids for the management of breakthrough

cancer pain in adults: A systematic review undertaken as part of

an EPCRC opioid guidelines project. Palliat Med, 25(5), 516–524.

doi:10.1177/0269216310385601

Zeppetella, G., O’Doherty, C.A., & Collins, S. (2000). Prevalence and

characteristics of breakthrough pain in cancer patients admitted

to a hospice. [Clinical Trial]. J Pain Symptom Manage, 20(2),

–92.

Zeppetella, G., & Ribeiro, M.D. (2003). Pharmacotherapy of cancerrelated

episodic pain. [Review]. Expert Opin Pharmacother, 4(4),

–502. doi:10.1517/14656566.4.4.493


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