Patients who suffered from breakthrough pain incurred costs of approximately $12,000 a year on medical services specific to their pain(hospitalizations, emergency room and physician visits), while patients who did not have breakthrough pain, but still experienced pain, incurred costs of approximately $2,400 a year.
“Breakthrough pain is an often overlooked consequence of cancer. We know that it can significantly impact quality of life and recovery, but this is one of the first studies to demonstrate a relationship between breakthrough pain and the increased need for medical attention, resulting in higher medical costs,” said the lead investigator, Barry Fortner, PhD, of the Department of Psychology and Cancer Symptom Research, West Clinic in Memphis, Tennessee and adjunct professor at the University of Memphis.
Breakthrough pain is a flare-up of pain characterized by rapid onset, severe intensity and short duration. It occurs despite effective control of pain with scheduled analgesics used to control pain around-the-clock.
While data are limited on the prevalence of breakthrough pain, it is estimated that as many as 67 percent of those being treated for cancer pain experience breakthrough pain. The pain can be spontaneous and unprompted, or brought on by an action as simple as swallowing, coughing or moving.
Breakthrough pain generally has the same source as persistent pain – causes can range from the cancer itself to cancer treatments.
STUDY RESULTS AND METHODOLOGY
According to the findings, more than half of the patients surveyed (53 percent; 527 patients) had experienced pain since being diagnosed with cancer. Of these, 49 percent (256 patients) had taken an analgesic on a regular schedule to treat their pain, 63 percent (160 patients) of whom suffered from breakthrough pain (BTP).
All patients who experienced pain were asked about the need for any of three medical services because of pain: hospitalization, emergency room visits, and doctor visits. On average, BTP patients were significantly more likely to experience pain-related hospitalizations and physician office visits than non-BTP patients. Thirty-seven percent of BTP patients (59 patients) vs. 23 percent of non-BTP patients (20 patients) reported pain-related hospitalizations. Fifty-six percent of BTP patients (90 patients) vs. 37 percent of non-BTP patients (33 patients) visited their doctor because of pain.
“Less than one-third of cancer patients in the study reported taking medication on a regular basis to treat their pain, and of these individuals, more than half reported suffering from breakthrough pain,” said Dr. Fortner. “This situation is of major concern especially since we have widely accepted treatment strategies to effectively control cancer pain, including one particular treatment designed to help manage breakthrough pain,” he added.
While the authors note that patients who reported having breakthrough pain may actually have been suffering from uncontrolled cancer pain in general, Dr. Fortner believes that the study results signal a need to look more carefully at how breakthrough pain is being assessed and managed among cancer patients.
The findings from this study are based on a nonrandom sample of 1,000 cancer patients contacted using standard telephone survey techniques. A pool of eligible applicants for the survey was generated through a consumer survey in which respondents indicated that a member of their immediate family had cancer. Calls were subsequently made to talk with the individual with cancer.
Patients responded to a series of questions related to their pain, including: experience with pain, if they believed it was related to the cancer, use and schedule of pain medications, and rating the effectiveness of their scheduled pain medication. Patients who indicated that they had taken prescribed and scheduled analgesics were asked whether they suffered from “any flares of pain or pain attacks” between doses of their analgesic medication. Patients who responded affirmatively were assigned to the BTP group; patients who suffered from pain, but not BTP, were defined as the non-BTP group.
Costs estimates were generated by taking the number of hospitalizations, emergency department visits, and physician office visits for each patient and dividing them by the total number of years since diagnosis of cancer. These figures were multiplied by the average cost for each medical service (as reported in medical literature) and then averaged on a per year basis.
The study was sponsored by Cephalon, Inc.
The West Clinic, founded in 1979, leaves "No Stone Unturned" in its commitment as a World-Class Center of excellence in Oncology, Hematology, Radiology, and other Medical Care. As a major private practice center for Oncology Research, the West Clinic is involved in dozens of research protocols. The West Clinic has also pioneered a number of studies related to pain. These ultimately led the developing the "Cancer Care Monitor" which is a "State-of-the-Art" medical technology that assesses a wide array of symptoms that accompany patients who are diagnosed with cancer.
Journal
Journal of Pain