Assessment of Breakthrough Cancer Pain Among Female Patients With Cancer: Knowledge, Management and Characterization in the IOPS-MS Study

Abstract

Background/aim: Chronic secondary pain from cancer may flare into unexpected acute phases, called breakthrough cancer pain (BTcP). This phenomenon has a moderate-to-severe intensity and short latency between onset and peak of intensity, so clinical and therapeutic implications may be necessary. The Italian Oncologic Pain Multisetting-Multicentric Survey (IOPS-MS) aimed to characterize BTcP in a large number of patients from different settings and assess possible factors influencing its development. Previously, we observed differences according to sex in site, onset and level of BTcP. In this analysis, we assessed differences in non-predictable BTcP between female patients with female-specific cancer (FSC) (including breast and gynecological cancer) and those with non-FSC.

Patients and methods: A univariate analysis compared patients with FSC (overall and separately for breast and gynecological cancer) and non-FSC. A multivariate analysis stratified by BTcP phenotype was performed to estimate the main determinants of the risk groups in patients with FSC (overall and separately for breast and gynecological cancer) and non-FSC. Odds ratios and 95% confidence intervals were reported.

Results: The FSC group was younger, more often treated in clinics or day hospitals, and had an increased risk of locoregional/metastatic disease than the non-FSC group. Patients with breast cancer were at higher risk of locoregional/metastatic disease, less frequently treated by a palliative specialist and had later BTcP onset compared to the non-FSC group. Significant differences concerning age, care setting and BTcP onset were also found in the group of patients with FSC (overall and separately for breast and gynecological cancer) according to tumor extension.

Conclusion: Non-predictable BTcP in patients with FSC presents unique characteristics, particularly regarding pain onset, care settings, and metastasis. Differences between breast and gynecological cancer emphasize the need for tailored pain-management approaches.

Keywords: BTcP; Non-predictable breakthrough cancer pain; breast cancer; cluster analysis; gynecological cancer.