Healthcare Consultancy, Maidenhead, UK.
Pain Relief and Palliative Care Unit, La Maddalena Cancer Centre, Palermo, Italy.
Eur J Pain. 2018 Aug;22(7):1362-1374. doi: 10.1002/ejp.1225. Epub 2018 May 21.
Confusion remains over the definition of breakthrough cancer pain (BTcP) potentially leading to delayed diagnosis and treatment.
An on-line survey was conducted in four EU countries among relevant healthcare professionals and cancer patients diagnosed with BTcP. The roles of healthcare professionals (HCPs) were examined and their knowledge and use of available medications recorded. Patients were questioned on how BTcP affected their lives and on the medications they had received/were receiving.
There was a 'time lag' of 58 and 13 weeks in Germany and Spain respectively between the initial diagnosis of BTcP and its treatment. Four in ten oncologists across the four countries considered themselves not fully confident in their choice of the appropriate therapy. A quarter of patients in Germany, Italy and Spain and four in ten in France were treated only with increased dosages of the therapy already prescribed for their background pain - often morphine. Almost another quarter received morphine in addition to their treatment for background pain. Oncologists indicated a need for faster-acting treatments revealing a potential lack of awareness of rapid onset oral opioids and patients expressed a desire for more effective pain relief and better psychological support.
There is a need for a universal definition of BTcP to facilitate earlier and more accurate diagnosis. It is essential that BTcP is treated immediately on diagnosis with therapies that more closely mirror its temporal characteristics to ensure that patients' desire for more effective pain relief is fulfilled.
Many cancer patients suffered episodes of BTcP needlessly over many months due to missed diagnosis. Even after diagnosis, many physicians were not fully confident in their choice of 'rescue' therapy which perhaps is not surprising given the very low level of awareness of treatment guidelines, both national and international.
突破性癌症疼痛（BTcP）的定义仍存在混淆，可能导致诊断和治疗的延误。
在四个欧盟国家，对相关医护人员和被诊断为 BTcP 的癌症患者进行了在线调查。检查了医护人员的作用，并记录了他们对现有药物的了解和使用情况。询问了患者 BTcP 如何影响他们的生活，以及他们接受/正在接受的药物。
在德国和西班牙，从 BTcP 的初始诊断到治疗分别有 58 周和 13 周的“时间滞后”。四个国家的十分之四的肿瘤学家认为自己对选择适当的治疗方法没有完全有信心。四分之一的德国、意大利和西班牙的患者和十分之四的法国患者仅接受了已为其背景疼痛开具的剂量增加的治疗——通常是吗啡。几乎还有四分之一的患者在接受背景疼痛治疗的同时还接受了吗啡治疗。肿瘤学家表示需要更快起效的治疗方法，这表明他们可能对快速起效的口服阿片类药物认识不足，而患者则表示希望获得更有效的疼痛缓解和更好的心理支持。
需要一个普遍的 BTcP 定义，以促进更早、更准确的诊断。在诊断时立即用更能反映其时间特征的疗法治疗 BTcP 至关重要，以确保患者对更有效的疼痛缓解的需求得到满足。
由于诊断失误，许多癌症患者在数月内不必要地经历了多次 BTcP 发作。即使在诊断后，许多医生对他们选择的“抢救”治疗也没有完全有信心，这也许并不奇怪，因为他们对国家和国际的治疗指南都知之甚少。
