Daeninck, P., Gagnon, B., Gallagher, R., Henderson, J.D., Shir, Y., Zimmermann, C., & Lapointe, B. (2016). Canadian recommendations for the management of breakthrough cancer pain. Current Oncology, 23, 96–108. 

DOI Link

Purpose & Patient Population

PURPOSE: To assist Canadian healthcare providers and policymakers in the decision-making process in managing breakthrough cancer pain (BTCP), and to improve outcomes and quality of life (QOL) for patients with cancer
 
TYPES OF PATIENTS ADDRESSED: Breakthrough cancer pain and cancer pain are the key topics investigated.

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: It started with review of literature. Each member of the expert panel was assigned a specific topic to review references to ensure relevance and acceptable methodologic quality. Consensus meeting was in Montreal, Quebec.
 
DATABASES USED: PubMed and Cochrane Library
 
INCLUSION CRITERIA: References from January 2008 to December 2014, as well as a manual search of references cited in selected papers published in peer-reviewed journals

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Palliative care 

Results Provided in the Reference

Not clearly listed in article. Article focused on the consensus points and education points. Prior to those sections, a general section regarding the literature was included.

Guidelines & Recommendations

  • BTCP is not the same as background pain or end-of-dose pain.
  • Assess pain for evidence of BTCP using algorithm such as the one by Davies et al. Recommend assessment of pain using 1–10 scale. Studies of the outcomes in patients who are assessed and managed using the assessment tools needs to be completed.
  • Manage pain by considering the cause of the pain. Optimize control of background analgesia and background pain before trying to treat BTCP.
  • The most common approach to manage BTCP in Canada includes the use of traditional short-acting opioids.
  • Using up to 20% of total daily opioid dose to treat BTCP is reasonable. Consider using different formulations for background and breakthrough pain.
  • Transmucosal fentanyl formulations are beneficial over traditional methods. Pharmacologic properties of the fentanyl formulation should be matched with the characteristics of the BTCP. Never use transmucosal fentanyl formulations in opioid-naïve patients. Injectable fentanyl and sufentanil can be used sublingually or intranasally in the inpatient setting; not recommended in outpatient setting.
  • Concerns regarding opioid abuse and dependence should not prevent clinicians from using opioids in patients with a life expectancy less than three months.

Limitations

  • Developed for use in Canada and may not be generalizable to areas outside Canada

Nursing Implications

Understanding BTCP is vital for nurses to adequately manage pain. Nurses need to be aware of the available guidelines since they are usually at the sharp end of managing pain. With this knowledge, nurses can educate patients and families regarding the proper use of medications to manage pain, specifically BTCP.