Breakthrough cancer pain management (BTcP)-gap analysis of the current Australian landscape

Lee, W; Nagla, A; Wong, ABO; Magann, L; Lovell, M; Mantle, E; Reed, K; Aggarwal, G; Wong, AK; Pene, C; Allcroft, P; Crawford, GB; Michael, N

Author(s): Lee, W; Nagla, A; Wong, ABO; Magann, L; Lovell, M; Mantle, E; Reed, K; Aggarwal, G; Wong, AK; Pene, C; Allcroft, P; Crawford, GB; Michael, N;
Details: Publication Year 2026-03-11,Volume 34,Issue #4,Page 301
Journal Title: Supportive Care in Cancer
Publication Type: Research article
Abstract: 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.
Publisher: Springer Nature
Keywords: Humans; Australia; *Cancer Pain/drug therapy/diagnosis; *Analgesics, Opioid/administration & dosage/therapeutic use; *Breakthrough Pain/drug therapy/diagnosis; *Pain Management/methods; Practice Guidelines as Topic; Breakthrough cancer pain; Cancer pain; Opioids; Pain management; Palliative care; Research gaps
Department(s): Palliative Care
Publisher's Version: https://doi.org/10.1007/s00520-026-10518-z
Open Access at Publisher's Site: https://doi.org/10.1007/s00520-026-10518-z
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-04-07 12:09:45

Last Modified: 2026-04-07 12:10:00