Hospital General Universitario de Valencia, Avenida Tres Cruces, 2, 46014, Valencia, Spain.
Consorcio Hospital Provincial de Castellón, Avenida del Dr. Clarà, 19, 12002 Castellón, Spain.
J Geriatr Oncol. 2019 Jul;10(4):643-652. doi: 10.1016/j.jgo.2019.03.012. Epub 2019 Apr 26.
We aimed to generate expert-based recommendations on the management of breakthrough cancer pain (BTcP) in older patients with cancer.
A two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of statements using a nine-point Likert scale (one = totally disagree and nine = totally agree). Statements were classified as appropriate (median ranged from seven to nine), irrelevant (median ranged from four to six) or inappropriate (median ranged from one to three). Consensus was established when at least two thirds of the panel scored within any of the ranges.
A total of 64 specialists from pain units (44.4%), palliative care units (25.4%), medical oncology (19.1%), geriatric medicine (7.9%) and others (3.2%), participated in two consultation rounds. Specialists agreed that effective coordination between the different specialties and levels of care is essential for proper management of BTcP. Most participants (81.3%) supported the assessment of frailty and resolved (96.8%) that frailty status is a better indicator of patient needs than biological age. Participants agreed (75.8%) in the application of the Davies algorithm for diagnosis of BTcP in older patients. A strong consensus was achieved regarding which pharmacological treatment (transmucosal fentanyl) and dosing method (start low and go slow) are the most suitable for the older population. No agreement was reached on how interventionist techniques should be integrated into the therapeutic strategy for BTcP.
The present Delphi has generated a set of recommendations that will help healthcare professionals in the management of BTcP in older patients.
我们旨在为癌症老年患者突破性癌痛（BTcP）的管理提供基于专家的建议。
两轮多学科 Delphi 研究。专家使用九点 Likert 量表（1=完全不同意，9=完全同意）对一组陈述的同意程度进行评分。陈述被归类为合适（中位数范围为 7 到 9）、不相关（中位数范围为 4 到 6）或不合适（中位数范围为 1 到 3）。当至少三分之二的小组在任何范围内评分时，即达成共识。
共有来自疼痛科（44.4%）、姑息治疗科（25.4%）、肿瘤内科（19.1%）、老年医学科（7.9%）和其他科室（3.2%）的 64 名专家参加了两轮咨询。专家们一致认为，不同专业和护理水平之间的有效协调对于 BTcP 的妥善管理至关重要。大多数参与者（81.3%）支持评估脆弱性，并明确（96.8%）脆弱状态是患者需求的更好指标，而不是生物年龄。参与者一致认为（75.8%）应在老年患者中应用 Davies 算法诊断 BTcP。在哪些药物治疗（经黏膜芬太尼）和剂量方案（从低剂量开始缓慢增加）最适合老年人群方面达成了强烈共识。对于如何将介入技术纳入 BTcP 的治疗策略，尚未达成共识。
目前的 Delphi 研究产生了一套建议，将有助于医疗保健专业人员管理老年患者的 BTcP。
