Breakthrough Cancer Pain Initiative

What is the Breakthrough Cancer Pain Initiative?

The Breakthrough Cancer Pain Initiative is a nurse-driven initiative launched with the purpose of improving breakthrough pain management in cancer patients. Patient surveys demonstrate that breakthrough cancer pain is under-recognised, sub-optimally treated and therefore subject of intense patient discomfort.

Oncology nurses have an important role in identifying and managing breakthrough cancer pain and in referring difficult cases to pain specialists. The Breakthrough Cancer Pain Initiative will therefore look into the general understanding of breakthrough cancer pain amongst oncology nurses, confidence in treating these episodes, examples of best practice as well as gaps in current practice.

What does the Breakthrough Cancer Pain Initiative involve?

A European working group of oncology nurses has been formed to drive the Breakthrough Cancer Pain Initiative. The working group consists of:

  • Jenske Geerling, The Netherlands (guideline lead)
  • Theodora Pappa, Greece
  • Carina Rundström, Sweden
  • Prof. Tone Rustøen, Norway
  • Isolde Weisse, Germany
  • Sian Williams, United Kingdom
  • Bostjan Zavratnik, Slovenia

A multidisciplinary advisory group has been formed to provide expert advice based on their knowledge within palliative care in general and Breakthrough Cancer Pain in particular. The advisory group consists of:

  • Dr Andrew Davies, United Kingdom
  • Prof. Stein Kaasa, Norway
  • Dr Barry Quinn, United Kingdom (booklet lead)
  • Prof. Yvonne Wengstrøm, Sweden

Working group activities

Breakthrough cancer pain survey

A survey amongst oncology nurses in the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Norway, Slovenia, Sweden, The Netherlands and United Kingdom has been carried out. The survey demonstrated an unmet educational need and a link between lack of training and/or assessment tools and the ability to distinguish breakthrough cancer pain from background pain and the nurses' confidence in advising patients about breakthrough cancer pain.

The survey results were presented at the European Multidisciplinary Cancer Congress (EMCC) in Stockholm 24 September 2011. Download the presentation and see the webcast in the Further information section on the right.

EONS Breakthrough Cancer Pain guideline

Utilising the framework for existing EONS guidelines, the working group is developing a set of nurse-specific evidence- and practice-based guidelines on breakthrough cancer pain management. The guideline reflected the findings of the above-mentioned survey and are the first to address breakthrough cancer pain management from a nurse perspective.

The objective of the guideline is to provide guidance on assessment, identification and treatment of breakthrough cancer pain, which will serve as a platform to implement nurse-specific training programs. Specific targets and aims of the guidelines are:

  • Increase nurses' knowledge of specific elements of breakthrough cancer pain
  • Causes for breakthrough cancer pain
  • Features and symptoms of breakthrough cancer pain
  • Differences between end of dose pain and transitory breakthrough cancer pain
  • Consequences of breakthrough cancer pain
  • Treatment measures
  • Support nurses to assess and identify breakthrough cancer pain
  • Encourage successful management of breakthrough cancer pain
  • Update and inform nurses of the current guidelines based on previously published evidence

The breakthrough cancer pain guideline is published on this website. In addition, a complementary pocket guide was developed and piloted during the pain management workshop at the EAPC Congress in Prague in 2013. This pocket guide is also published on this website.
+  Read the guidelines
+  Read the pocket guide

The guideline was also presented at The European Multidisciplinary Cancer Congress. Download the presentation and see the webcast in the Further information section on the right.

The guidelines were launched at a training workshop during the European Cancer Congress in Amsterdam in September 2013.

More information

Please contact Clair Watts from the Breakthrough Cancer Pain Initiative with any questions or to request further information. You may do this directly from the contact EONS page.


Phase I of this work (survey) was supported by an educational grant provided by Nycomed.

Phase II of this work (guideline and booklet) was supported by an educational grant provided by Takeda.

Phase III of this work (workshops at EMCC and EAPC) was supported by an educational grant provided by Takeda.