Breakthrough pain in advanced cancer patients followed at home: a longitudinal study.

The aim of this study was to longitudinally assess breakthrough pain (BP) in advanced cancer patients who were admitted to home palliative care. One hundred and one consecutive patients who were admitted to one of the two home care programs and were representative of the cancer population followed at home in Italy were included. Patients were excluded only if at admission they were cognitively impaired or too unwell to provide reliable answers to questions regarding data collection. At admission (T(0)), and one month later (T(1)), data were recorded about the pharmacological treatment of background pain and its effectiveness; the presence of BP and its intensity, duration, and number of episodes; the occurrence of BP induced by movement; spontaneous relief after stopping activity and limitation of physical activity because of pain on movement; the analgesic drugs prescribed for BP; and the effectiveness of BP medication. After the initial assessment, patients received analgesics for background pain and BP, as well as symptomatic treatment usually provided at home, according to local policies and protocols. At T(0), 70.2% of patients were receiving analgesic drugs, and 52% of them had uncontrolled pain. BP was reported by 49.2% of these patients and had a mean duration and number of episodes per day of 35.1 minutes (+/-35.0) and 2.4 (+/-1.5), respectively. Of patients with BP, 65.7% had pain on movement, which decreased spontaneously after stopping activity in 73.9%. Physical activity was strongly limited in 78.2% of these patients. Most patients did not have a BP medication prescription. At T(1), a larger number of patients were receiving analgesics (P<0.002), and the number of patients with BP medication significantly increased (P<0.001). The incidence of BP and pain on movement decreased (33% and 38.5%, respectively). This longitudinal study suggests that BP is a dynamic entity dependent on several factors, including analgesic treatment and the course of disease. This helps explain the different incidences reported in previous studies performed in different settings and conditions.