The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
Opioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study...
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doaj-565dc767a2684b1cb6344ac9c7c8b0ce2020-11-24T22:52:32ZengMDPI AGCancers2072-66942018-12-011111810.3390/cancers11010018cancers11010018The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer PatientsSara Campagna0Riccardo Sperlinga1Antonella Milo2Simona Sannuto3Fabio Acquafredda4Andrea Saini5Silvia Gonella6Alfredo Berruti7Giorgio Vittorio Scagliotti8Marco Tampellini9Department of Public Health and Pediatrics, University of Torino, 10126 Torino, ItalySchool of Nursing, Catholic University of the Sacred Heart, Cottolengo Hospital, 10152 Torino, ItalyFARO Foundation—Hospice Sergio Sugliano, 10121 Torino, ItalySchool of Nursing, Catholic University of the Sacred Heart, Cottolengo Hospital, 10152 Torino, ItalySchool of Nursing, Catholic University of the Sacred Heart, Cottolengo Hospital, 10152 Torino, ItalyMedical Oncology, University of Torino; Department of Oncology, San Luigi Gonzaga Hospital, 10043 Orbassano, ItalyDepartment of Public Health and Pediatrics, University of Torino, 10126 Torino, ItalyDepartment of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia, ASST-Spedali Civili, 25123 Brescia, ItalyMedical Oncology, University of Torino; Department of Oncology, San Luigi Gonzaga Hospital, 10043 Orbassano, ItalyMedical Oncology, University of Torino; Department of Oncology, San Luigi Gonzaga Hospital, 10043 Orbassano, ItalyOpioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed at verifying the existence of a circadian rhythm of BTP episodes in terminally-ill cancer patients. Consecutive adult cancer patients at their EOL treated with long-acting major opioids to control background pain (Numeric Rating Scale ≤ 3/10) were recruited from two Italian palliative care services. Using a personal diary, patients recorded the frequency and onset of BTP episodes and the analgesic rescue therapy taken for each episode over a 7-day period. Rhythms identified in BTP episodes were validated by Cosinor analysis. Overall, 101 patients were enrolled; nine died during the study period. A total of 665 BTP episodes were recorded (average of 7.2 episodes, mean square error 0.8) per patient, with 80.6% of episodes recorded between 8:00 a.m. and 12:00 a.m. At Cosinor analysis, a circadian rhythm of BTP episodes was observed, with a Midline Estimating Statistics of the Rhythm (MESOR) of 1.5, a double amplitude of 1.8, and an acrophase at 12:30 p.m. (p < 0.001). Oral morphine was the most frequent analgesic rescue therapy employed. In terminally-ill cancer patients, BTP episodes follow a circadian rhythm; thus, tailoring the timing of opioid administration to this rhythm may prevent such episodes. This circadian rhythm of BTP episodes in terminally-ill cancer patients should be confirmed in larger samples.http://www.mdpi.com/2072-6694/11/1/18analgesicsbreakthrough paincircadian rhythmneoplasmspalliative carequality of life |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sara Campagna Riccardo Sperlinga Antonella Milo Simona Sannuto Fabio Acquafredda Andrea Saini Silvia Gonella Alfredo Berruti Giorgio Vittorio Scagliotti Marco Tampellini |
spellingShingle |
Sara Campagna Riccardo Sperlinga Antonella Milo Simona Sannuto Fabio Acquafredda Andrea Saini Silvia Gonella Alfredo Berruti Giorgio Vittorio Scagliotti Marco Tampellini The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients Cancers analgesics breakthrough pain circadian rhythm neoplasms palliative care quality of life |
author_facet |
Sara Campagna Riccardo Sperlinga Antonella Milo Simona Sannuto Fabio Acquafredda Andrea Saini Silvia Gonella Alfredo Berruti Giorgio Vittorio Scagliotti Marco Tampellini |
author_sort |
Sara Campagna |
title |
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients |
title_short |
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients |
title_full |
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients |
title_fullStr |
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients |
title_full_unstemmed |
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients |
title_sort |
circadian rhythm of breakthrough pain episodes in terminally-ill cancer patients |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2018-12-01 |
description |
Opioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed at verifying the existence of a circadian rhythm of BTP episodes in terminally-ill cancer patients. Consecutive adult cancer patients at their EOL treated with long-acting major opioids to control background pain (Numeric Rating Scale ≤ 3/10) were recruited from two Italian palliative care services. Using a personal diary, patients recorded the frequency and onset of BTP episodes and the analgesic rescue therapy taken for each episode over a 7-day period. Rhythms identified in BTP episodes were validated by Cosinor analysis. Overall, 101 patients were enrolled; nine died during the study period. A total of 665 BTP episodes were recorded (average of 7.2 episodes, mean square error 0.8) per patient, with 80.6% of episodes recorded between 8:00 a.m. and 12:00 a.m. At Cosinor analysis, a circadian rhythm of BTP episodes was observed, with a Midline Estimating Statistics of the Rhythm (MESOR) of 1.5, a double amplitude of 1.8, and an acrophase at 12:30 p.m. (p < 0.001). Oral morphine was the most frequent analgesic rescue therapy employed. In terminally-ill cancer patients, BTP episodes follow a circadian rhythm; thus, tailoring the timing of opioid administration to this rhythm may prevent such episodes. This circadian rhythm of BTP episodes in terminally-ill cancer patients should be confirmed in larger samples. |
topic |
analgesics breakthrough pain circadian rhythm neoplasms palliative care quality of life |
url |
http://www.mdpi.com/2072-6694/11/1/18 |
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