Management of Breakthrough cancer pain (BTcP) in Italy: needs and options

Breakthrough cancer pain (BTcP) is a transitory exacerbation of pain on abackground of well-controlled pain with a rapid onset and a short duration. Conventional analgesic drugs are generally not effective. Currently, there is controversy among healthcare professionals and patients regarding the use of opioids for BTcP. This study was aimed to present a literature review to analyze the BTcP management in Italy. A literature review was performed during the period October 2014-March 2015 by consulting the main electronic databases and institutional websites. Specific key words and MeSH terms were used. There is a lack of precision about important aspects of BTcP including classification, epidemiology and assessment. In Italy epidemiological data reported a prevalence of 59.2% and high heterogeneity among the setting observed: lower rates were reported in hospitals (39.9%) and higher in hospice (80.5%). BTcP episodes generally occur from 1 to 4 times a day, but specific tools for diagnosing need to be developed. Furthermore BTcP intensity is underestimated. BTcP uncontrolled or poorly controlled can cause consuming of more health care resources and represents a social cost in terms of patient and caregivers’ productivity. Traditionally oral opioids represent the only strategy for treatment with a lot of prejudices that can cause ineffective and inadequate dosage. New drugs have been developed to have rapid onset (10-15 minutes) and good tolerability, nevertheless their consumption are still very low in Italy. After the introduction of the law 38/2010 local networks of palliative care and pain management are implementing in several Italian Regions and university training courses are established to managing analgesia and palliative care among medical practitioners. Considering the high prevalence of BTcP observed and the underuse of available therapeutic options, Italian healthcare service needs to develop new approaches to improve quality of palliative care for patients. Key messages: For the management of BTcP patient’s characteristics, time of onset, intensity, location and particular features need to be accurately assessed and palliative care structures should be strengthened New drugs can achieve successful outcomes in order to get a better management for patients, doctors and caregivers