Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital

Area of Science:

• Oncology
• Palliative Care
• Pain Management

Background:

• Cancer pain management (CPM) often involves breakthrough (BTO) and scheduled (SCH) opioids.
• Understanding the BTO/SCH ratio is crucial for optimizing pain control and treatment efficacy.
• Supportive care consults (SCC) may impact opioid prescribing patterns in cancer patients.

Purpose of the Study:

• To analyze the frequency and prescription patterns of BTO and SCH opioids.
• To evaluate the BTO/SCH ratio before and after referral to an inpatient SCC.
• To assess the impact of SCC on opioid utilization for cancer pain.

Main Methods:

• Retrospective review of cancer patients receiving BTO and SCH opioids for ≥24 hours.
• Analysis of opioid types, routes, daily doses (MEDDs), and BTO/SCH ratios pre-SCC and during SCC.
• Definition of a normal BTO ratio as 0.5-0.2.

Main Results:

• 91% of patients were evaluable, with higher median pain scores and opioid MEDDs in the SCC group.
• The BTO/SCH ratio was frequently prescribed above the recommended threshold (>0.2) in 37.5% of patients.
• BTO/SCH ratios increased from 0.10 (pre-SCC) to 0.17 (SCC), indicating a shift in prescribing patterns.

Conclusions:

• BTO/SCH ratios are often prescribed higher than recommended, suggesting potential for improved pain management strategies.
• Supportive care consults were associated with increased opioid doses but fewer BTO doses per day.
• Further research is needed to optimize BTO/SCH ratios for effective cancer pain management.