Investigators from Memphis found that cancer patients
who experience breakthrough pain require additional medical services that result
in higher medical costs than those incurred by cancer patients without
breakthrough pain. The study, published in the February 2002 issue of the
Journal of Pain, reported that patients with breakthrough pain (perhaps
two-thirds of this population) require more frequent hospitalizations and doctor
visits than cancer patients without breakthrough pain. Patients who suffered
from breakthrough pain incurred costs of approximately $12,000 a year for
medical services specific to their pain (hospitalizations, emergency room, and
physician visits), whereas patients who did not have breakthrough pain (but
still experienced pain) incurred costs of approximately $2,400 a year.
"Breakthrough pain is an often overlooked consequence of cancer. We know
that it can significantly impact quality of life and recovery, but this is one
of the first studies to demonstrate a relationship between breakthrough pain and
the increased need for medical attention, resulting in higher medical
costs," said lead investigator Barry Fortner, PhD, department of psychology
and cancer symptom research, West Clinic, in Memphis and adjunct professor at
the University of Memphis.
Although data on the prevalence of breakthrough pain are limited, it is
estimated that as many as 67% of those being treated for cancer pain experience
breakthrough pain. The pain can be spontaneous and unprompted, or brought on by
an action as simple as swallowing, coughing, or moving. Breakthrough pain
generally derives from the same source as persistent pain, with causes ranging
from the cancer itself to cancer treatments.
Study Results and Methodology
According to the study, which was sponsored by Cephalon, manufacturer of oral
transmucosal fentanyl (Actiq), 53% of the 527 patients surveyed experienced some
degree of pain since being diagnosed with cancer. Of these, 49% (256 patients)
had taken an analgesic on a regular basis to treat the pain, with 63% (160
patients) suffering from breakthrough pain.
All patients who experienced pain were asked about the need for any of three
medical services: hospitalization, emergency room visits, and doctor visits. On
average, patients with breakthrough pain were significantly more likely to
require pain-related hospitalizations and physician office visits than were
patients without breakthrough pain. Pain-related hospitalizations were reported
for 59 patients (37%) with breakthrough pain vs 20 patients (23%) without
breakthrough pain. Doctor visits were prompted by breakthrough pain in 90
patients (56%) and nonbreakthrough pain in 33 patients (37%).
"Less than one-third of cancer patients in the study reported taking
medication on a regular basis to treat their pain, and of these individuals,
more than half reported suffering from breakthrough pain," Dr. Fortner
noted. "This situation is of major concern, especially since we have widely
accepted treatment strategies to effectively control cancer pain, including one
particular treatment designed to help manage breakthrough pain," he added.