title: Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study.
abstract: BACKGROUND
  There is no unanimous consensus on the clinical features to define breakthrough cancer pain (BTcP). The current project aimed to investigate the opinion of a panel of experts on cancer pain on how to define, diagnose, assess, treat and monitor BTcP.
  
  
  METHODS
  A two-round Spanish multi-centre exploratory Delphi study was conducted with medical experts (n = 90) previously selected from Medical Oncology Services, Radiation Oncology, Palliative Care/Home Care Teams, and Pain Units. The study intended to seek experts' consensus and to define a set of recommendations for the management of BTcP.
  
  
  RESULTS
  It was generally agreed that, definition of BTcP implies that baseline pain should be controlled (84 %), although not necessarily with opioids (only 30 %); there must be exacerbations (98.9 %); the duration of each episode should last <1 h (70 %); the intensity of pain ≥7 out of 10 (67.8 %); and the number of flares per day should not be less than four. All participants supported the use of the Davies algorithm for the diagnosis. The use of a 'Patient Diary' was highly recommended. The optimal treatment should have a rapid onset, a short-acting analgesic effect (1-2 h) and transmucosal nasal or oral administration. It was considered very important to develop protocols for the management of cancer pain.
  
  
  CONCLUSIONS
  The present Delphi study identified a set of recommendations to define, assess and monitor BTcP.
authors: Unidad de Hospitalización Domiciliaria y Cuidados Paliativos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Avd. Doctor Fedriani, 3, 41071, Seville, Spain. bocetajaime@gmail.com.
authors: J
authors: J
authors: Boceta
authors: Servicio de Oncología Radioterápica, Hospital Universitario Puerta del Hierro, Madrid, Spain.
authors: A
authors: A
authors: De la Torre
authors: S. Anestesiología, Clínica del Dolor, Hospital Germans Trias i Pujol, Barcelona, Spain.
authors: D
authors: D
authors: Samper
authors: Medical Department, TEVA Pharma, Madrid, Spain.
authors: M
authors: M
authors: Farto
authors: Medical Department, TEVA Pharma, Madrid, Spain.
authors: R
authors: R
authors: Sánchez-de la Rosa
mesh_terms: D059390:Breakthrough Pain / Q000175:diagnosis* / Q000628:therapy*; D000072716:Cancer Pain / Q000175:diagnosis* / Q000628:therapy*; D003697:Delphi Technique; D059408:Pain Management / Q000379:methods
keywords: Baseline cancer pain; Breakthrough cancer pain; Cancer; Consensus; Delphi; Management