Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Physician's Attitude toward Treating Breakthrough Cancer Pain in Korea

  • Seo, Min Seok (Department of Family Medicine, Incheon St. Mary Hospital, The Catholic University of Korea College of Medicine) ;
  • Shim, Jae Yong (Department of Family Medicine, Severance Hospital, Yonsei University of College of Medicine) ;
  • Choi, Youn Seon (Korea University Guro Hospital) ;
  • Kim, Do Yeun (Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Hwang, In Gyu (Chung-Ang University College of Medicine) ;
  • Baek, Sun Kyung (Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Shin, Jin Young (Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine) ;
  • Lee, Juneyoung (Department of Biostatistics, Korea University College of Medicine) ;
  • Lee, Chang Geol (Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2016.07.22
  • Accepted : 2017.01.24
  • Published : 2017.03.01
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Abstract

Purpose: Adequate control of breakthrough pain is essential for patients with cancer. Managing breakthrough pain mainly depends on understanding the concept of breakthrough pain and the proper usage of rescue medication by physicians. This study aims to assess the attitudes and practice patterns of palliative physicians in managing breakthrough pain for patients in Korea. Methods: This study was based on data from the 2014 breakthrough cancer pain survey conducted by the Korean Society for Hospice and Palliative Care. One hundred physicians participated in the online survey. Among total 33 self-reported questionnaires, twelve items were selected in this analysis. Results: Rapid onset of action is the main influencing factor in selecting rescue opioids. Oral oxycodone (65%) and parenteral morphine (27%) are commonly used. A few physicians (3%) prefer to use transmucosal fentanyl. The percentage of physicians prescribing oral oxycodone due to its rapid onset of action is just 21.5%, whereas the percentage of physicians using parenteral morphine is 81.5%. Two thirds of respondents (66%) answered that breakthrough pain is not well controlled with rescue medications. Conclusion: There is a gap between the needs of physicians in terms of the perceived difficulties of managing breakthrough cancer pain and their practice patterns selecting rescue medications.

목적: 돌발성 통증을 적절히 조절하는 것은 암환자에서 필수적이다. 돌발성 통증을 조절하는 것은 의료진이 돌발성 통증에 대해 잘 이해하고 적절한 구제 진통제를 사용하는 것에 달려있다. 본 연구는 한국 완화의료 전문의들의 돌발성 통증에 대한 견해와 진료 형태에 대해 알아보고자 하였다. 방법: 본 연구는 한국호스피스 완화의료학회에서 시행된 2014년 돌발성 통증 설문조사를 바탕으로 진행하였다. 100명의 의사가 온라인 설문조사에 참여하였다. 총 33개의 자가 기입식 설문 문항 중에서 12개의 항목이 분석에 사용되었다. 결과: 빠른 작용 발현은 구제 진통제를 선택함에 있어 가장 중요한 요소였다. 경구 옥시코돈(65%)과 모르핀 주사제(27%)는 흔히 사용되는 구제진통제였다. 소수의 의사들(3%)만이 점막 흡수형 펜타닐을 선호하였다. 빠른 작용 발현 때문에 경구 옥시코돈을 선택한다고 답변한 의사들은 21.5%였으며, 반면에 빠른 작용 발현 때문에 모르핀 주사제를 처방한 의사들은 81.5%였다. 전체 응답자의 약 66%는 돌발성 통증이 구제 진통제로 잘 조절되지 않는다고 답변했다. 결론: 돌발성 통증 조절에 의료진들은 어려움을 느끼고 있었고, 의료진들이 구제진통제를 선택함에 있어서 필요로 하는 중요한 요소와 실제 처방의 형태에는 차이가 있었다.

Keywords

References

  1. Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G; Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 2009;13:331-8. https://doi.org/10.1016/j.ejpain.2008.06.014
  2. Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manage 2014;47:57-76. https://doi.org/10.1016/j.jpainsymman.2013.02.015
  3. Webber K, Davies AN, Cowie MR. Breakthrough pain: a qualitative study involving patients with advanced cancer. Support Care Cancer 2011;19:2041-6. https://doi.org/10.1007/s00520-010-1062-z
  4. Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain 2002;3:38-44.
  5. Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 2009;20:1420-33. https://doi.org/10.1093/annonc/mdp001
  6. Oldenmenger WH, Sillevis Smitt PA, van Dooren S, Stoter G, van der Rijt CC. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 2009;45:1370-80. https://doi.org/10.1016/j.ejca.2009.01.007
  7. Yates PM, Edwards HE, Nash RE, Walsh AM, Fentiman BJ, Skerman HM, et al. Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia. J Pain Symptom Manage 2002;23:393-405. https://doi.org/10.1016/S0885-3924(02)00387-1
  8. Bennett D, Burton AW, Fishman S, Fortner B, McCarberg B, Miaskowski C, et al. Consensus panel recommendations for the assessment and management of breakthrough pain. Part 2: management. P & T 2005;30:354-61.
  9. Zeppetella G. Opioids for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioid guidelines project. Palliat Med 2011;25:516-24. https://doi.org/10.1177/0269216310385601
  10. Davies AN. Breakthrough cancer pain. Curr Pain Headache Rep 2014;18:420. https://doi.org/10.1007/s11916-014-0420-9
  11. Mercadante S. Pharmacotherapy for breakthrough cancer pain. Drugs 2012;72:181-90. https://doi.org/10.2165/11597260-000000000-00000
  12. Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, et al. Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manage 2013;46:619-28. https://doi.org/10.1016/j.jpainsymman.2012.12.009
  13. Zeppetella G. Dynamics of breakthrough pain vs. pharmacokinetics of oral morphine: implications for management. Eur J Cancer Care (Engl) 2009;18:331-7. https://doi.org/10.1111/j.1365-2354.2008.01009.x
  14. Zeppetella G. Impact and management of breakthrough pain in cancer. Curr Opin Support Palliat Care 2009;3:1-6. https://doi.org/10.1097/SPC.0b013e3283260658
  15. Mercadante S, Villari P, Casuccio A. An Italian survey on the attitudes in treating breakthrough cancer pain in hospice. Support Care Cancer 2011;19:979-83. https://doi.org/10.1007/s00520-010-0919-5
  16. Bedard G, Davies A, McDonald R, Hawley P, Buchanan A, Popovic M, et al. Breakthrough cancer pain: a comparison of surveys with European and Canadian patients. Support Care Cancer 2015;23:791-6. https://doi.org/10.1007/s00520-014-2426-6
  17. Shin DW, Choi JY, Nam BH, Seo WS, Kim HY, Hwang EJ, et al. The Current Status of Utilization of Palliative Care Units in Korea: 6 month results of 2009 Korean Terminal Cancer Patient Information System. Korean J Hosp Palliat Care 2010;13:181-9.
  18. Lee MA, Yeom CH, Choi YS, Jang SK, Park JN, Song CH, et al. The frequency and distress score of symptom of cancer patients - for the development of Korean Cancer Pain Assessment Tool (K-CPAT). Korean J Hosp Palliat Care 2003;6:45-50.
  19. Koh SJ, Lee KS, Hong YS, Yoo YS, Park HJ. Clinical Change of Terminally Ill Cancer Patients at the End-of-life Time. Korean J Hosp Palliat Care 2008;11:99-105.
  20. Stanley TH. The Fentanyl Story. J Pain 2014;15:1215-26. https://doi.org/10.1016/j.jpain.2014.08.010
  21. Smith HS. Considerations in selecting rapid-onset opioids for the management of breakthrough pain. J Pain Res 2013;6:189-200.
  22. Rustoen T, Geerling JI, Pappa T, Rundstrom C, Weisse I, Williams SC, et al. A European survey of oncology nurse breakthrough cancer pain practices. Eur J Oncol Nurs 2013;17:95-100. https://doi.org/10.1016/j.ejon.2012.05.005
  23. Kim do Y, Ahn JS, Lee KH, Kim YC, Lee J, Kim SY. A nationwide survey of knowledge of and compliance with cancer pain management guidelines by Korean physicians. Cancer Res Treat 2014;46:131-40. https://doi.org/10.4143/crt.2014.46.2.131
  24. Wengstrom Y, Rundstrom C, Geerling J, Pappa T, Weisse I, Williams SC, et al. The management of breakthrough cancer pain-educational needs a European nursing survey. Eur J Cancer Care (Engl) 2014;23:121-8. https://doi.org/10.1111/ecc.12118
  25. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012;13:e58-68. https://doi.org/10.1016/S1470-2045(12)70040-2
  26. British Columbia. Guidelines & protocols: Palliative care for the patient with incurable cancer or advanced disease - Part 2: Pain and symptom management [Internet]. Victoria, B. C.; Province of British Columbia; 2011 [cited 2015 Jan 5]. Available from: http://www.bcguidelines.ca/guideline_palliative2.html.
  27. Doulton B. Pharmacologic management of adult breakthrough cancer pain. Can Fam Physician. 2014;60:1111-4.
  28. Ministry of Health and Welfare, National Cancer Center. Cancer pain management guideline [Internet]. 6th ed. Sejong, Goyang: Ministry of Health and Welfare, National Cancer Center; 2015 [cited 2016 Apr 19]. Available from: http://www.cancer.go.kr/ebook/135/PC/135.html.
  29. Hong SH, Roh SY, Kim SY, Shin SW, Kim CS, Choi JH, et al. Change in cancer pain management in Korea between 2001 and 2006: results of two nationwide surveys. J Pain Symptom Manage 2011;41:93-103. https://doi.org/10.1016/j.jpainsymman.2010.03.025
  30. Song JD, Lee SH, Jo KW. An Analysis of Relative Importance among Prescription Criteria Using the AHP (Analytic Hierarchy Process). Korean J Health Econ Policy 2013;19:99-127.

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