Circadian variation of breakthrough pain in cancer patients.
BACKGROUND
Breakthrough cancer pain (BTP) can place physical, psychological and economic burdens on patients and their productive life. By preventing instead of treating BTP after it occurs, the efficacy of analgesic treatment in cancer patients could be maximized. With this study, we investigated circadian variations in the occurrence of BTP events in cancer patients.


METHODS
The circadian variation of BTP was assessed in two different series (group 1, n = 47; group 2, n = 76) of advanced cancer patients suffering from severe chronic pain and undergoing analgesic treatment with major opioids.


RESULTS
BTP episodes showed a circadian pattern, with an acrophase occurring at 10:00 a.m. (p < 0.001) in all patients. When the two series of patients were considered separately, an acrophase was similarly observed, with 60% of BTP episodes recorded between 10:00 a.m. and 6:00 p.m. The circadian rhythm of BTP was maintained after stratifying the patients according to whether they had bone metastases or visceral metastases. BTP episodes negatively correlated with quality of life.


CONCLUSIONS
BTP onset follows a circadian rhythm, with an acrophase occurring in the late morning.
Medical Oncology, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Orbassano, Italy.
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Saini
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Tucci
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Tampellini
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Maina
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Bouraouia
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Giuliano
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Termine
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Castellano
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Campagna
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Laciura
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Berruti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000503:physiopathology; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology*; D010147:Pain Measurement; D010166:Palliative Care; D011446:Prospective Studies; D011788:Quality of Life; D012463:Saliva / Q000378:metabolism; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D006854:Hydrocortisone