Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

Abstract

Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that “breaks through” a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) is a subtype of BTcP that occurs in the absence of any specific activity. Since NP-BTcP has an important clinical impact, this analysis is aimed at characterizing the NP-BTcP phenomenon through a multidimensional statistical technique. This is a secondary analysis based on the Italian Oncologic Pain multiSetting—Multicentric Survey (IOPS-MS). A correlation analysis was performed to characterize the NP-BTcP profile about its intensity, number of episodes per day, and type. The multiple correspondence analysis (MCA) determined the identification of four groups (phenotypes). A univariate analysis was performed to assess differences between the four phenotypes and selected covariates. The four phenotypes represent the hierarchical classification according to the status of NP-BTcP: from the best (phenotype 1) to the worst (phenotype 4). The univariate analysis found a significant association between the onset time >10 min in the phenotype 1 (37.3%)’ vs. the onset > 10 min in phenotype 4 (25.8%) (p < 0.001). Phenotype 1 was characterized by the gastrointestinal type of cancer (26.4%) with respect to phenotype 4, where the most frequent cancer affected the lung (28.8%) (p < 0.001). Phenotype 4 was mainly managed with rapid-onset opioids, while in phenotype 1, many patients were treated with oral, subcutaneous, or intravenous morphine (56.4% and 44.4%, respectively; p = 0.008). The ability to characterize NP-BTcP can offer enormous benefits for the management of this serious aspect of cancer pain. Although requiring validation, this strategy can provide many indications for identifying the diagnostic and therapeutic gaps in NP-BTcP management.

Open Issues and Practical Suggestions for Telemedicine in Chronic Pain

“…After each visit a medical report must be delivered; predisposed forms can be designed, and an identical delivery system, such as email, should be routinely used. As an example, patients with musculoskeletal chronic pain are very likely to benefit from an assiduous follow-up performed with a multidimensional assessment made possible and affordable by the introduction of telemedicine [ 35 , 36 , 37 ].…”

Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study

“…For example, in patients with gastrointestinal cancers and pain conditions, nutritional needs are the main cause of an increased number of unscheduled hospital admissions (14). Addressing neuropathic pain is usually a great challenge (15). Probably, patients suffering from this subtype of cancer pain require greater attention because they are more candidates for visits in person to reevaluate drug therapy or for invasive pain management (16).…”

Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs

“…However, many episodes of BTcP still remain not recognized and lead to a deleterious impact on the HRQoL [ 10 ]. Despite further studies on BTcP being mandatory, our results can add useful elements to the understanding of a clinical phenomenon that has not yet been exhaustively investigated [ 38 ].…”