Breakthrough Pain in Cancer Patients

Chicago—Patients with cancer who had breakthrough pain were statistically significantly more likely to have daily functioning problems compared with cancer patients who are pain-free, according to a database analysis of commercially-insured health plan members. Patients with pain had impairments in activity, mood, work, school, sleep, and family and home life.

Results were presented during a poster session at the ASCO meeting. The poster was titled Effect of Breakthrough Pain on Functional Status, Pain Interference, and Disability in Cancer Patients: Findings from the National Breakthrough Pain Survey.

The authors noted that previous studies found 33% to 89% of patients with controlled, persistent pain had breakthrough pain, defined as a transitory exacerbation of pain in patients who are already receiving long-term opioid therapy to manage their pain. However, few of the patients in the surveys came from outpatient settings.

In this study, the authors used the National Breakthrough Pain Survey and identified people with commercial insurance who were in the HealthCore Integrated Research Database. The database included 6.4 million patients from 14 health plans in the United States who were ≥18 years of age and enrolled continuously for ≥12 months.

After reviewing International Classification of Diseases, Ninth Revision, Clinical Modification codes and pharmacy prescription claims, the authors divided eligible patients into a control group and pain groups. This subanalysis examined 33 patients who had cancer but did not have breakthrough pain as well as 112 patients with cancer and breakthrough pain. The patients had a cancer diagnosis, ≥2 claims for chronic pain separated by ≥3 months, and controlled, persistent pain.

The authors contacted patients and confirmed that they had chronic pain and took opioids on a daily basis. They used the Brief Pain Inventory (BPI)-Short Form to assess the severity and impact of pain in the past 24 hours, the Sheehan Disability Scale (SDS) to assess functional disability and productivity, and the 12-item Short-Form Health Survey (SF-12) to measure functional health and well being. They also measured pain symptom severity, breakthrough pain characteristics, functionality, quality of life, and lost productivity.  In addition, following the survey phase, the authors identified administrative claims from the database for the patients.

The mean BPI pain interference score for cancer patients with breakthrough pain during the past 24 hours was 34.7 compared with 23.4 for those without breakthrough pain (P=.003). For the past 7 days, the mean BPI pain interference score for cancer patients with breakthrough pain was 36.5 compared with 25.0 for those without breakthrough pain (P=.001).

During the past 24 hours, patients with breakthrough pain also had statistically significant impairments in activity (P=.005), mood (P=.02), ability to work (P=.04), and sleep (P=.04). The differences were statistically significant for the past 7 days, too: activity (P=.003), mood (P=.03), ability to work (P=.001), and sleep (P=.006).

According to the SDS, breakthrough pain was associated with statistically significantly greater global functioning impairment (P=.03), including missing work or school (P=.005) and issues with family or home life (P=.02).

As assessed by the SF-12, breakthrough pain was associated with statistically significant decrease in quality of life (P=.021), but there was no difference in the mental component of the survey (P=.307).

Cephalon, Inc, a wholly owned subsidiary of Teva Pharmaceuticals Industries, Ltd, sponsored this study.