Survey calls for greater clinical consensus on diagnosis, treatment of breakthrough cancer pain

Cohn & WolfeOct 1 2011

European oncology nurse survey calls for greater clinical consensus on diagnosis and treatment of breakthrough cancer pain; new guidelines are on their way

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.

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 Rust-en, 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 Rust-en 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.

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.

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.

- 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.