A scoping review of breakthrough cancer pain: Multidimensional patient needs and influencing factors

Breakthrough cancer pain (BTcP), a common complication among cancer patients, has been confirmed to have extensive impacts on patients' lives. However, existing research remains fragmented, lacking a systematic theoretical framework to integrate these findings. This scoping review aimed to systematically examine the multidimensional needs and influencing factors of BTcP patients based on Kolcaba's Comfort Theory, construct a conceptual mapping of BTcP needs and influences, and explore the theoretical foundations and practical pathways of related interventions.

Using a scoping review methodology, we retrieved literature on BTcP impact studies from databases including PubMed, MEDLINE, CINAHL, Embase, Web of Science, Scopus, AMED, and Google Scholar, deadline for searching the database is January 2025. We qualitatively integrated existing research results using the Comfort Theory's four dimensions (physical, psychological, social, environmental) and three stages (needs assessment, intervention implementation, effect evaluation) as an organizational framework.

A total of 30 studies were included. The findings revealed that BTcP patients' needs are multidimensional, with interactions between different dimensions forming a complex network of needs. Eleven key characteristic categories of BTcP impacts were extracted. Within the Comfort Theory's four-dimensional framework: Physical comfort dimension primarily addressed functional impacts, sleep influences, and treatment experiences; Psychological comfort dimension encompassed psychological impacts, quality of life (psychological aspects), and psychological treatment barriers; Social comfort dimension focused on work and social activity impacts, economic influences, caregiver burden, and communication challenges; Environmental comfort dimension included system support needs and related treatment barriers, Additionally, two intervention studies were discovered, providing preliminary evidence for BTcP management under the Comfort Theory's three-stage framework.

This study is the first to systematically integrate BTcP impact factor research using Comfort Theory, constructing a multidimensional conceptual map of BTcP influences. The findings reveal that BTcP impacts extend far beyond pain itself, involving various aspects of patient life. The Comfort Theory framework facilitates comprehensive assessment and intervention of BTcP in clinical practice. Future research should focus on developing and evaluating interventions addressing comfort needs across different dimensions.