title: Impact of breakthrough pain on community-dwelling cancer patients: results from the National Breakthrough Pain Study.
abstract: OBJECTIVE
  To characterize cancer-related breakthrough pain (BTcP) among community-dwelling patients with cancer.
  
  
  METHODS
  Data from the National Breakthrough Pain Study, a cross-sectional observational survey describing breakthrough pain (BTP) in the community, were analyzed for a subset of patients with BTcP. Eligible patients were community-dwelling adults with commercial insurance and insurance claims consistent with cancer and chronic pain who consented to a structured telephone interview. Assessments included the Brief Pain Inventory-Short Form (BPI), the Short Form 12 Health Survey, the Sheehan Disability Scale, the Work Performance Questionnaire, Generalized Anxiety Disorder-7 Screener, and Patient Health Questionnaire-2.
  
  
  RESULTS
  In total, 112 patients with cancer pain also experienced BTcP; 83.3% were in remission. Most patients reported experiencing ≥2 BTcP episodes per day, a median time to BTcP peak of 15 minutes, and a median duration of BTcP of 30 minutes. Mild pain at onset that gradually worsened was reported by 54.5% of patients, and incidental pain triggered by physical activity was reported by 58.0%. Most patients who reported using a medication to manage BTcP received an oral immediate-release opioid, such as oxycodone or hydrocodone, and only 1 received a rapid-onset opioid; few (24.1%) reported that pharmacologic treatment for BTcP worked every time. Patients reported mean (standard deviation) BPI scores of 4.2 (1.75) and 5.7 (1.98) for average and worst pain intensity during the preceding 24 hours, respectively, and high interference with activity, mood, ability to walk and work, social relations, sleep, and enjoyment of life.
  
  
  CONCLUSIONS
  Results indicate that BTcP among community-dwelling patients with cancer continues to be a health burden and reveals opportunities to improve its management.
authors.affiliation: a Tufts University School of Medicine , Boston , MA , USA.|b Analgesic Solutions , Natick , MA , USA.
authors.forename: Nathaniel P
authors.initials: NP
authors.lastname: Katz
authors.affiliation: c Global HEOR , Teva Pharmaceuticals, Inc ., Frazer , PA , USA.
authors.forename: Kavita L
authors.initials: KL
authors.lastname: Gajria
authors.affiliation: d EPI-Q, Inc ., Oak Brook , IL , USA.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Shillington
authors.affiliation: e HealthCore, Inc ., Wilmington , DE , USA.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.affiliation: d EPI-Q, Inc ., Oak Brook , IL , USA.
authors.forename: Qing
authors.initials: Q
authors.lastname: Harshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059390:Breakthrough Pain / Q000188:drug therapy*; D059350:Chronic Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use*; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010098:Oxycodone / Q000627:therapeutic use*; D010147:Pain Measurement / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D006853:Hydrocodone; D010098:Oxycodone
keywords: Breakthrough pain; cancer; opioids; patient-reported outcomes; quality of life; survey