Symptom Relief from Breakthrough Cancer Pain: An Evaluation of Patient Satisfaction

Breakthrough cancer pain—episodes of intense pain experienced by many cancer patients despite around-the-clock treatment with opioids—can be effectively managed with a fentanyl-based oral spray.

Using fentanyl sublingual spray for the treatment of breakthrough cancer pain (BTCP) markedly improved patient satisfaction when compared with previous drug therapies, according to a study that was recently presented at PAINweek 2012 in Las Vegas, Nevada.

The study consisted of an open-level titration phase (26 days) in which an optimal drug dose—one that produced effective analgesia for 2 consecutive BTCP episodes—was determined for each of the 130 opioid-tolerant participants. The study only enrolled cancer patients who reported 1 to 4 episodes of BTCP a day. Ninety-six of the subjects were then enrolled in a 26-day double-blind phase and received 7 units of the study drug and 3 units of placebo.

Investigators used the Treatment Satisfaction Questionnaire for Medication (TSQM) at baseline to measure satisfaction with prior BTCP therapies and at the end of titration to evaluate satisfaction with fentanyl sublingual spray. They also performed a global evaluation of the study medication at both 30 and 60 minutes postdose.

Patient symptom relief improved from baseline to end of titration, increasing from 27% with prior therapies to 88% with fentanyl sublingual spray. Global evaluation scores at 30 and 60 minutes were also significantly improved for the fetanyl spray group when compared with the placebo group.

Reports of adverse events slightly decreased from the titration phase (60%) to the double-blind treatment phase (48.9%).

“Lack of funding of chronic pain research and chronic pain initiatives has resulted in a relative dearth of new drugs and therapies over the past decades and has held back developments in the area of chronic pain, one of the most debilitating chronic disease states as reported by the National Institutes of Health,” said lead author Richard L. Rauck, MD, executive director of the Center for Clinical Research at the Carolinas Pain Institute, in a release unrelated to the study.

BTCP is believed to occur in approximately one-third of patients being treated for cancer and up to 80% of patients with late-stage disease, according to Insys Pharmceuticals Inc, a specialty pharmacy company that makes the spray.