Breakthrough Pain in Cancer Associated With Increased Medical Services and Costs

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(Drug information on 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.