Breakthrough cancer pain management (BTcP)—gap analysis of the current Australian landscape
For cancer nurses, the paper offers a useful overview of where care varies—and highlights opportunities to improve recognition, assessment, and more consistent, patient-centred management.
Purpose
Breakthrough cancer pain (BTcP) is an evolving clinical challenge, with limited guideline-specific direction. This study aimed to identify gaps in breakthrough cancer pain (BTcP) diagnosis and management in Australia and propose practical, evidence-informed actions to improve assessment, prescribing and equitable access to effective analgesia.
Methods
A gap analysis was conducted between September 2023 and September 2024, using three hybrid roundtable meetings involving 13 medical and nursing clinicians and researchers. Participants were selected for expertise in BTcP, including rapid-onset opioids (ROOs) policy development, BTcP research and education. A targeted review of the literature and guidelines framed the discussions. Meetings were recorded, transcribed and iteratively member-checked; thematic synthesis identified key gaps and potential solutions.
Results
Five interrelated gaps were identified: (1) inconsistent definitions of BTcP undermining case identification and research comparability; (2) assessment and measurement gaps with uptake of validated tools limited by perceived respondent burden and clinical utility; (3) heterogeneous approach to BTcP with limited comparative evidence guiding ROOs versus immediate-release opioid use and dosing strategies; (4) implementation and systems barriers including workflow, prescribing complexity and clinician training needs; (5) equity in opioid supply and restricted access to vulnerable populations. Recommended actions include Delphi consensus on definition, development and validation of subtype-sensitive assessment tools, pragmatic comparative effectiveness and implementation studies, co-designed prescribing templates and stakeholder engagement to address supply chain and regulatory barriers.
Conclusions
Sequential, coordinated efforts—consensus building, measurement development, targeted research, co-designed implementation supports and supply chain planning—are required to advance equitable, evidence-based BTcP care in Australia.
In 2023, Menarini Australia supported and facilitated a series of roundtable discussions with a BtCP Expert Working Group of thirteen palliative care clinicians to explore current challenges in the definition, assessment, and management of breakthrough cancer pain in Australia. Following these discussions, the group developed this gap analysis to help inform future approaches to care and support more consistent, patient-centred management of BtCP. The publication was developed independently by the participating clinicians.
