Year 2019 / Volume 26 / Number 1

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Project adapta: adequacy of treatment in breakthrough cancer pain

Rev. Soc. Esp. Dolor. 2019; 26(1): 31-43 / DOI: 10.20986/resed.2018.3661/2018

Cecilio Alamo Gonzalez, Luis Cabezón Gutiérrez, Grupo de trabajo Proyecto ADAPTA


ABSTRACT

Introduction: Transmucosal fentanyl has specific properties which make it ideal for the treatment of breakthrough cancer pain (BTCP). Although there is a broad consensus for the administration of transmucosal fentanyl for BTCP in Spain, there is uncertainty as to the way oncologists adjust their prescription to the patient and what are the determinants of the choice of different pharmaceutical forms.
Objectives: The main objective of this study was to analyze and prioritize the attributes that Spanish oncologists consider when assessing treatment options with transmucosal fentanyl in patients with BTCP.
Methods: A Scientifi c Committee performed a classification of 14 relevant attributes in the prescription of transmucosal fentanyl for BTCP. Subsequently, a dossier of scientific evidence was generated comparing these 14 attributes among the different available transmucosal fentanyl formulations, which was shared with the panel of experts (115 Medical Oncologists). After a thorough review of the document, the participants carried out an online vote for the prioritization of the attributes.
Results: Out of fourteen attributes analyzed, seven achieved a consensus of ≥ 50 % of the participants: the start of the analgesic action (84 %), the adequacy of the effect of fentanyl to the BTCP episode (72 %), the ease of use (58 %), the presence of mucositis (57 %), the ease of titration of the optimal dose (57%), and the variety of presentations and doses available (59 %).
Conclusions: The most valued attributes were those related to the speed of action of the analgesic treatment and its adaptation to the BTCP profile, something to be expected given the spontaneous, unpredictable, and transitory nature of BTCP. As less valued attributes appear the risk of abuse or aberrant behavior and the presence of rhinitis for its administration, which indicates that the existence of these factors do not influence the choice of treatment for BTCP. These results will allow medical oncologists to know what attributes should be taken into account when customizing the patient's treatment of BTCP in order to improve the adequacy of rescue analgesia.



RESUMEN

Introducción: El fentanilo de administración transmucosa tiene características específicas que lo convierten en el fármaco adecuado para el tratamiento del dolor irruptivo oncológico (DIO). Aunque en España existe un amplio consenso sobre la idoneidad de la administración de fentanilo transmucoso para el DIO, es relevante conocer cómo los oncólogos adecuan su prescripción al paciente y cuáles son los factores determinantes de la elección de las diferentes formas farmacéuticas.
Objetivos: El objetivo principal de este proyecto fue identificar y priorizar los atributos que los oncólogos médicos españoles tienen en cuenta cuando valoran las opciones de tratamiento con fentanilo transmucoso en pacientes con DIO.
Métodos: Un comité científico realizó una tipificación de 14 atributos relevantes en la prescripción de fentanilo transmucoso para el DIO. Posteriormente se generó un dossier de evidencia científica comparando estos 14 atributos entre los distintos fentanilos transmucosos disponibles, que se compartió con el panel de expertos (115 oncólogos médicos). Tras una exhaustiva revisión del documento, los participantes realizaron una votación online de priorización de los atributos.
Resultados: De catorce atributos analizados, siete consiguieron un consenso de ≥ 50 % de los participantes: el inicio de la acción analgésica (84 %), la adecuación del efecto del fentanilo al perfi l del episodio de DIO (72 %), la facilidad de uso por los pacientes y cuidadores (69 %), la duración del efecto (58 %), la presencia de mucositis (57 %), la facilidad de titulación de la dosis óptima (57 %) y las presentaciones y dosis disponibles (59 %).
Conclusiones: Los atributos más valorados fueron los relativos a la rapidez de acción del tratamiento analgésico y su adaptación al perfil del DIO, algo esperable dadas las características clínicas del episodio de DIO. Como atributos menos valorados aparecen el riesgo de abuso o conductas aberrantes y la presencia de rinitis para su administración, lo que indica que la existencia de estos factores no tiene tanta infl uencia en la elección del tratamiento para el abordaje del DIO. Estos resultados permitirán a los oncólogos médicos conocer qué atributos deben ser tenidos en cuenta a la hora de personalizar los tratamientos del paciente con DIO con el objetivo de mejorar la adecuación de la analgesia de rescate.





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Alamo Gonzalez C, Cabezón Gutiérrez L, Proyecto ADAPTA G. Project adapta: adequacy of treatment in breakthrough cancer pain. Rev Soc Esp Dolor 2019; 26(1): 31-43 / DOI: 1020986/resed20183661/2018


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Ficha Técnica

Recibido: 24/01/2018

Aceptado: 25/04/2018

Prepublicado: 25/06/2018

Publicado: 07/03/2019

Tiempo de revisión del artículo: 89 días

Tiempo de prepublicación: 152 días

Tiempo de edición del artículo: 407 días


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