Abstract
Dear Editor:
The treatment of cancer-related pain has its own specific challenges, like pain divided in background pain and breakthrough pain (BTP). 1 Forty to ninety percent of patients experience breakthrough pain (BTP), which is severe, has an onset within minutes, and a short duration (30-45 minutes) that occurs against a background of otherwise controlled, persistent pain. 2 BTP can be managed by intranasal (IN) fentanyl (Instanyl®).3–5 Knowledge of patients' preferences and attitudes toward IN fentanyl is important when deciding whether or not to use it; however, little is known about satisfaction with this treatment. The main goal of our study was to determine patients' satisfaction with IN fentanyl and the pain reduction achieved.
Patients (>18 years) were considered eligible for inclusion if they used IN fentanyl. The study protocol was approved by the medical ethics committee of the Maastricht University Medical Center+, is registered at www.trialregister.nl (NTR2880) and written informed consent was obtained from all participants. Treatment satisfaction with IN fentanyl was measured by using the Treatment Satisfaction Questionnaire for Medication (TSQM). 6 The validated self-report TSQM questionnaire consists of 14 items in four scales (range 0-100): effectiveness, side effects, convenience, and global satisfaction. Pain was measured with an 11-point numeric rating scale (NRS). All data analyses were performed using SPSS 18.0 (SPSS Inc., Chicago, IL).
Twenty-five patients, mainly with cancer-related BTP, gave informed consent. Fifteen female and ten male patients participated, mean age 59.0 years (SD=13.7; range 29-78) and mean Body Mass Index (BMI) 24.0 (SD=4.1; range 17-33).
The mean SD scores and ranges for treatment satisfaction are shown in Table 1. IN fentanyl provided clinically meaningful pain relief (≥2 points reduction in pain intensity) 7 in 20 patients (80%). In this group TSQM effectiveness was significantly related to reduction in pain intensity (p<0.05).
Scales from 0-100 in which 0 means not satisfied at all and 100 means extremely satisfied.
Patients scored more than 50 points on each of the four TSQM scales, indicating that they were (very) satisfied. Patients were mostly very satisfied with the severity and frequency of adverse events of IN fentanyl. TSQM convenience was related to patients' age, with younger patients finding IN fentanyl more convenient to use than older patients. In conclusion, patients were satisfied with IN fentanyl as treatment for BTP.