Author contributions br Janice Kwon
Janice Kwon: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, writing - original draft and writing – review and editing; Anna Tinker: data curation; writing – review and editing; Gillian Hanley: formal anal-ysis, investigation, methodology, writing – review and editing; Gary Pansegrau: data curation, investigation, writing –review and editing; Sophie Sun: investigation, writing – review and editing; Mark Carey: in-vestigation, writing – review and editing; Intan Schrader: formal analy-sis, investigation, writing – review and editing.
UBC Division of Gynecologic Oncology Research Award.
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Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/locate/oraloncology
Breakthrough pain in patients with head & neck cancer. A secondary analysis of IOPS MS study
Sebastiano Mercadantea, , Francesco Masedub, Marco Valentib, Federica Aiellic
a Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy
b Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy
c Department of Medical Oncology, AUSL Teramo, Italy
Head and neck cancer
Aim: To characterize breakthrough pain (BTcP) in patients with Head and neck (H&N) cancer.
Methods: This was a secondary analysis of multicenter study of BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, and the mean time to meaningful pain relief after taking medication, were assessed. The presence of mucositis was also assessed.
Results: 205 patients with H&N cancer were examined. The mean number of BTcP episodes was 2.8/day, which was higher than in general population. The mean intensity of BTcP was 7.4. BTcP was more predictable in H&N cancer than in other tumors. The main trigger of predictable BTcP was the ingestion of food (76.5%). BTcP onset was fast in 148 patients (72.2%). The mean time to meaningful pain relief after taking a BTcP medication was 15.3 min and BTcP interference with daily activity was relevant in most patients (89.2%). Transdermal drugs and nasal fentanyl preparations were more frequently used for background pain and BTcP, respectively. A consistent number of patients with H&N cancer (38.5%) exhibited diﬀerent levels of oral mucositis.
Conclusion: BTcP in patients with H&N cancer is characterized by a larger number of episodes/day and the predictability, particularly with ingestion of food. The use of drugs for background analgesia and BTcP were conditioned by the possible interference with swallowing or local mucosal damage.
More than half million of new cases of head and neck (H&N) cancer are diagnosed worldwide each year, possibly due to rising alcohol and tobacco consumption and increased sun exposure, as well as human papilloma virus . Patients with H&N cancer frequently experience pain, even long after the completion of treatment. The prevalence of pain among this population has been estimated at 70%, which is higher than what has been observed in other types of cancer . Pain ex-perienced one year after diagnosis has been found to be predictive of poor quality of life, disability  and shorter survival , particularly in the advanced stage of disease . Of interest, orofacial pain onset has been also reported to predict transition to H&N cancer .