Consensus on the Diagnosis and Management of Patients with Breakthrough Cancer Pain (BTcP), Including Procedural BTcP: DIOPRO Study

To develop consensus recommendations for improving the diagnosis and treatment of breakthrough cancer pain (BTcP), including procedural BTcP, the opinions of 107 medical experts in managing patients with cancer in Spain were collected using a two-round Delphi method. Consensus was assessed for 76 items using a Likert scale (1-9). Agreement was reached when the median (MED) score was ≥ 7 and the interquartile range (IQR) ≤ 3, while disagreement was considered when MED was ≤ 3 and IQR was ≤ 3. Consensus was reached on 90% of the statements. Experts agreed on the main characteristics of BTcP, which may have a variable number of episodes per day and occur in patients with opioid-controlled background pain. There was resounding agreement on the need to evaluate pain severity, both background and breakthrough cancer pain, in patients with cancer, involving adequately trained physicians and nursing staff. Procedural BTcP, a subtype of BTcP, is common in cancer diagnosis and/or treatment procedures. For this, premedication with an appropriate fast-acting, short-duration drug is necessary. These findings highlight the need for standardized protocols and specific training to improve the quality of life of patients suffering from BTcP, including procedural BTcP, and the efficiency of healthcare resource management.