Rev. Soc. Esp. Dolor. 2021; 28(1): 19-26 / DOI: 10.20986/resed.2021.3824/2020
Rafael López, Pablo Borrega, Antonio Antón, Enrique Aranda, Alfredo Carrato, Manuel Constenla, Juan Jesús Cruz, Eduardo Díaz-Rubio, Margarita Feyjóo, Jesús García-Foncillas, Pere Gascón, Vicente Guillem, Carlos Camps
RESUMEN
Introducción: El objetivo de este estudio fue evaluar la percepción de los oncólogos sobre la adherencia al tratamiento con opioides para el dolor irruptivo oncológico (DIO) en la práctica clínica real. El estudio también incluyó una evaluación de otros aspectos del manejo del DIO, como las razones de la no adherencia, la adecuación del tratamiento, o las posibles intervenciones necesarias para mejorar la adherencia.
Métodos: Este estudio observacional multicéntrico se realizó en 84 hospitales de toda España. Los oncólogos fueron encuestados por medio de un cuestionario online sobre su manejo del dolor oncológico basal y del DIO, y su percepción de la adherencia a los tratamientos.
Resultados: Los oncólogos (n = 97) indicaron que su primera opción para el DIO fue el fentanilo (varias formulaciones), con alta tolerancia (> 76 % de los pacientes). La mayoría de los oncólogos (96,8 %) evaluaron la adherencia en sus pacientes, pero solo el 69,1 % siempre prescribió medicamentos para prevenir los efectos adversos de los opioides, y solo el 74,2 % siempre tituló la dosis mínima. La mayoría de los oncólogos (51 %) percibieron que el 25-50 % de los pacientes no mostraban buena adherencia al tratamiento para DIO. La adherencia a los tratamientos de dolor basal fue alta, aunque muchos oncólogos consideraron que los pacientes generalmente dejaban de tomar el medicamento cuando se sentían mejor. Las principales razones para la no adherencia fueron la sensación de que el tratamiento era innecesario, la ineficacia percibida del tratamiento, la preocupación por los posibles efectos adversos y la falta de apoyo familiar.
Conclusiones: Los oncólogos percibieron que la adherencia al tratamiento para el DIO puede mejorarse y recomendaron el tratamiento de los efectos adversos de la medicación, una mejor educación sobre el manejo del dolor a los pacientes y familiares, instrucciones escritas de prescripción y simplificación de los regímenes de medicamentos.
ABSTRACT
Objectives: The objective of this study was to evaluate the perception of oncologists on adherence to opioid treatment for breakthrough cancer pain (BTcP) in current clinical practice. Our study also included an assessment of other aspects of the management of BTcP, such as the reasons for non-adherence, the adequacy of the treatment, or the possible interventions required to improve adherence.
Methods: This observational, multicentric study was carried out in 84 hospitals throughout Spain. Oncologists were surveyed by means of an online questionnaire on their management of background cancer pain and BTcP, and their perception of adherence to the treatments.
Results: Oncologists (N = 97) reported that their first choice for BTcP was fentanyl (various formulations), with high perceived tolerance (> 76 % of patients). Most oncologists (96.8 %) evaluated adherence in their patients but only 69. 1% always prescribed medication to prevent adverse effects of opioids and only 74.2 % always titrated the minimum dose. Most oncologists (51.0 %) perceived that 25-50 % of the patients did not adhere to the treatment for BTcP. Adherence to background pain treatments was high, although many oncologists considered that patients usually stopped taking the medication when feeling better. The main reported reasons for non-adherence were the self-perceived feeling that treatment was unnecessary, perceived inefficacy of the treatment, concerns about potential adverse effects, and lack of family support.
Conclusions: Oncologists perceived that adherenceto BTcP treatment can be improved and recommended treatment of adverse effects, better education about pain management to patients and relatives, written prescription instructions, and simplification of drug regimens.
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