Treatment of pain in cancer patients is a major health issue. Standard treatment of cancer pain will attempt to control different types of pain. Since up to two-thirds of patients with advanced cancer will have BTP, this phenomenon represents problem in clinical management. BTP episodes limit patient mobility, affect a patient's mood and limit social interactions. BTP patients, furthermore, sustain higher costs of care.
Supplemental analgesic agents ("rescue analgesics") are crucially important in the management of BTP. However, it must be acknowledged that optimally administered conventional treatment of BTP, specifically the oral dose, is likely to be inadequate for a substantial proportion of patients. Therefore, novel routes of drug delivery are needed. Non-invasive administration is preferred, due to ease of administration. Fentanyl is a well known, and well-characterized opioid, logical to use in BTP because of pharmacological properties.
OTFC is the first drug formulation specifically designed for BTP. Studies as well as clinical experience demonstrate the efficacy and safety of OTFC with an analgesic effect comparable to that of intravenous fentanyl, without the need for an i.v. line. This gives a short time to effect and with a short duration of action. Actiq has been used in Norway for several years. A series of clinical cases will be presented. Most patients achieved pain relief. Reasons for failure were mainly poor patient compliance, side effects and extended titration period. Important lessons learned were meticulous patient selection, vigorous titration, careful follow up and treatment of side effects. Finding the right dose for BTP can be challenging, but with OTFC does not necessarily need to be time-consuming and cumbersome. Rapid titration is possible through careful patient-instruction and coaching.