SAN ANTONIO, Tex.–All opioids are currently recommended for breakthrough cancer pain and clinicians may use the opioid of their choice, a study presented at the ONS 41st Annual Congress has shown.1

“Breakthrough cancer pain is defined as a transient exacerbation of pain or episodic pain that fails to be controlled and breaks through regularly scheduled opioid treatment,” said Jeannine Brant, PhD, APRN, AOCN.

An estimated 21% to 70% of patients with cancer experience breakthrough cancer pain on a daily basis. It is typically severe, peaks rapidly, and can occur spontaneously and can ultimately negatively affect patients’ mood, activity, relationships, sleep, and overall quality of life. Therefore, oncology nurse researchers sought to examine pharmacologic treatment for breakthrough cancer pain by conducting a systematic review.

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For the study, 1 team member analyzed findings from 3 meta-analyses; 3 systematic reviews; 21 research studies, most of which were randomized-controlled studies; and 2 guidelines that included more than 10 000 participants.

“It is important to acknowledge that opioids are often not studied in cancer pain,” Brant noted.

All studies were then discussed with a team of 20 oncology nurses with experience in systematic reviews and pain management. The investigators then classified each study into 1 of 5 Putting Evidence into Practice categories: recommended for practice, likely to be effective, benefits balanced with harms, effectiveness not established, or not recommended for practice.

Based on their findings, the team established all opioids as recommended for practice. They also found that transmucosal immediate-release fentanyl demonstrated more rapid onset of relief and tend to closely mimic episodes of breakthrough cancer pain.

“We recommend that opioids should be dose proportional to basal dose,” Brant said. “The breakthrough dose should be 10% to 20% of the basal dose, but this does not apply to transmucosal immediate release fentanyl opioids.”

The investigators noted that further studies are necessary to compare traditional opioids, such as morphine and oxycodone, with transmucosal immediate-release fentanyl opioids. Trial comparing transmucosal immediate-release fentanyl opioids are also warranted.


1. Brant JM, McLeod K, Randall M, et al. Breakthrough cancer pain (BTCP): putting evidence into practice. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.