Managing Radiotherapy-Induced Breakthrough Cancer Pain

Managing Radiotherapy-Induced Breakthrough Cancer Pain
Managing Radiotherapy-Induced Breakthrough Cancer Pain

Inadequate control of cancer pain and breakthrough pain during radiation therapy planning and treatment procedures can interrupt treatment schedules and impact the accurate delivery of therapeutic radiation doses to tumor tissue, diminishing the potential benefits of radiotherapy. A recent study demonstrated that fentanyl pectin nasal spray quickly alleviates breakthrough cancer pain during radiotherapy procedure positioning.

Cancer pain affects more than half of patients but is an often-neglected facet of cancer treatment planning and delivery.1 This is particularly true for cancer radiotherapy, which has a complex relationship with cancer pain. For example, radiotherapy plays an important role in helping to relieve cancer pain, such as that arising from bone metastases. But cancer pain can also disrupt the planning and delivery of therapeutic irradiation to tumors. 2,3

Breakthrough cancer pain is a particular challenge with no one solution for all patients. Episodes are transitory, often described as flares.4 Flares can be predictable, but may also be unpredictable, and onset of pain can abruptly build up to maximum intensity in 3 to 30 minutes.1,4

Unlike oral biologics or infused chemotherapy agents, radiation therapy frequently requires patients to place their bodies in uncomfortable positions and hold those positions for simulation procedures and treatment-planning imaging in addition to the actual delivery of treatment fractions.2,3 These positions and maneuvers can trigger episodes of breakthrough pain.3

Breakthrough pain in this setting disrupts efforts to position the patient and execute the radiotherapy treatment plan. Furthermore, routine radiation therapy procedures and maneuvers can exacerbate breakthrough pain severity depending on the source of the cancer pain (eg, tumor location) and positioning maneuvers attempted.2,3 Surveys indicate that pain is poorly managed in as many as 39% of radiation oncology patients, diminishing patient adherence and radiation course completion on schedule.1,5,6  

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