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Stakeholder Insight: Cancer Pain - Physician survey highlights inadequacies in education and treatment
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Zahlen und Fakten zur Studie: | 247 seiten | |||||||||
| Inhalt der Studie: |
Introduction
Estimated to affect 6.7 million individuals across the seven major markets in 2009, the population of patients suffering from cancer pain is expected to increase in the future as elderly.....
Introduction Estimated to affect 6.7 million individuals across the seven major markets in 2009, the population of patients suffering from cancer pain is expected to increase in the future as elderly and minority populations drive the rising incidence of cancer. Coupling this patient dynamic with the inadequacies of current treatment, the cancer pain market remains an attractive prospect for drug manufacturers Scope *Snapshot of the cancer pain market based on a survey of 180 physicians, supplemented with interviews with seven key opinion leaders. *Overview of cancer pain prevalence, including three cancer pain subtypes: neuropathic, non-neuropathic and breakthrough pain. *Analysis of pharmacological treatment rates, first-line treatment trends at the class level and rate of progression to second-line treatment. *Assessment of physician perception of three branded analgesics, satisfaction with available treatments and unmet needs. Highlights Although almost all patients with severe cancer pain receive pharmacological treatment for their pain, the pharmacological treatment rates for mild and moderate cancer pain is sub-optimal. Additionally, over a fifth of breakthrough cancer pain patients do not receive pharmacological treatment. Oncologists initiate and manage analgesic treatment in 45% and 44% of patients with cancer pain, respectively, across the seven major markets. It is therefore important for manufacturers of analgesic treatments for cancer pain to target oncologists in their marketing efforts. Improved physician education represents the greatest unmet need in the treatment of all forms of cancer pain. This represents a key opportunity for manufacturers to provide education programs which inform physicians on methods of assessing pain, as well as the availability and appropriate use of analgesics for different subtypes of cancer pain. Reasons to Purchase *Understand differential treatment and unmet needs in key subtypes of cancer pain. *Target physicians more effectively, through an understanding of prescribing behavior and its influences *Use the interactive country-specific treatment trees and patient numbers to validate new product forecasting based on prevalence and treatment rates. Report Highlights [Studien Infos ausblenden] |
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TABLE OF CONTENTS CHAPTER 1 EXECUTIVE SUMMARY 3 Scope of the analysis 3 Datamonitor insight into the cancer pain market 3 Contributing experts 5 Related reports 5 Upcoming related reports 6 CHAPTER 2 INTRODUCTION AND SCOPE 16 Coverage of the Stakeholder Insight Survey 16 Epidemiology and patient segmentation 18 Assessment, treatment rates and professional involvement 18 Treatment options 18 Treatment trends 18 Key prescribing influences and brand assessment 19 Improving treatment outcomes 19 Assumptions and caveats 19 Future trends 20 CHAPTER 3 COUNTRY TREATMENT TREES 21 Introduction to treatment trees 21 US 22 Japan 25 France 28 Germany 31 Italy 34 Spain 37 UK 40 CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION 43 Disease definition 44 Neuropathic and non-neuropathic cancer pain 44 Breakthrough pain 45 Etiology 46 Cancer pain may be caused by both the disease and associated treatments 46 Tumor growth often results in nociceptive pain 47 Chemotherapy, radiotherapy and surgery are key causes of treatment-related cancer pain 47 Breakthrough pain may occur spontaneously or be precipitated 48 For some cancer patients, pain may arise from pre-existing health conditions 49 Symptomatology 49 Acute versus chronic 50 Pain severity 50 Prevalence of cancer pain 51 An estimated 6.7 million individuals suffer from cancer pain across the seven major markets in 2009 51 Published epidemiological estimates of cancer pain prevalence vary widely 53 Neuropathic versus non-neuropathic cancer pain 58 Distinguishing between neuropathic and non-neuropathic pain is often difficult 58 Neuropathic cancer pain affects almost 2.3 million individuals across the seven major markets 59 Non-neuropathic cancer pain affects an estimated 4.4 million patients across the seven major markets 61 Breakthrough cancer pain 64 Almost 3.2 million patients with cancer pain suffer from breakthrough pain across the seven major markets 64 Trends in cancer pain prevalence 70 Pain prevalence typically increases with disease progression 70 Treatment-related chronic pain is common in cancer survivors 71 Projected increase in cancer rates will cause cancer pain population to grow 72 Impact of cancer pain 73 Cancer pain has a deleterious impact on quality of life 73 Breakthrough pain is a common cause of hospital admissions 74 CHAPTER 5 ASSESSMENT, PHARMACOLOGICAL TREATMENT RATES AND PROFESSIONAL INVOLVEMENT 75 Assessment of cancer pain 76 Pain subtype 77 Pain severity 78 Pharmacological treatment rates 80 Cancer pain is sub optimally treated across the seven major markets 80 Chronic neuropathic cancer pain 81 Chronic non-neuropathic cancer pain 85 Over a fifth of breakthrough cancer pain patients do not receive pharmacological treatment 88 Potential reasons for under-use of pharmacological treatments 90 Under-reporting of pain by patients 90 Inadequate pain assessment by physicians 92 Patient and physician concerns surrounding use of opioids 95 Professional involvement 97 Oncologists initiate analgesic treatment in the majority of cancer pain patients 98 Analgesic treatment is predominantly initiated by non-specialists in palliative care or pain medicine 100 Cancer pain treatment is largely managed by oncologists 101 Non-specialists in palliative care or pain medicine typically manage analgesic treatment 105 CHAPTER 6 TREATMENT OPTIONS AND CLINICAL GUIDELINES 106 Treatment options 107 Pharmacological treatment options 107 Non-steroidal anti-inflammatory drugs 107 Opioids 108 Antidepressants 110 Anticonvulsants 110 Other pharmaceutical treatment options 111 Treatment guidelines 112 The World Health Organization’s three-step ‘analgesic ladder’ 113 Only 50% of US physicians adhere to WHO cancer pain guidelines 115 Adherence to WHO guidelines is highest among UK-based physicians 117 American Pain Society 118 European Society for Medical Oncology 118 Scottish Intercollegiate Guidelines Network 118 Japanese Society for Palliative Medicine 119 CHAPTER 7 TREATMENT TRENDS 120 Trends in first-line treatment 121 The proportion of patients receiving the most commonly prescribed first-line drug therapy increases with pain severity 121 Chronic neuropathic and non-neuropathic cancer pain 121 Breakthrough cancer pain 123 Chronic neuropathic cancer pain 124 Mild 127 Moderate 128 Severe 130 Chronic non-neuropathic cancer pain 131 Mild 134 Moderate and severe 135 Breakthrough cancer pain 136 Progression to second-line analgesia 140 Chronic neuropathic cancer pain 141 Progression to second-line treatment among patients with chronic neuropathic cancer pain is highest in France 141 Other than failure to achieve pain relief, onset of action and gastrointestinal side effects are key factors considered by physicians 142 Chronic non-neuropathic cancer pain 144 Comparable proportions of patients with chronic non-neuropathic and neuropathic cancer pain progress to second-line analgesic treatment 145 Aside from failure to achieve pain relief, gastrointestinal side effects are a key factor considered by physicians 145 Breakthrough pain 147 Almost one third of breakthrough cancer pain patients progress to second-line treatment 147 Cost and lack of flexible dosing frequency are of least importance when physicians progress breakthrough cancer pain patients to second-line therapy 148 CHAPTER 8 PRESCRIBING INFLUENCES AND BRAND ASSESSMENT 150 Factors influencing physician decision making 151 Non-drug factors 151 Published guidelines represent the greatest non-drug influence on prescribing decisions 152 Drug factors 153 Neuropathic cancer pain 154 Breakthrough cancer pain 155 Physician perception of key brands 156 Total scores per drug 158 Overall score 160 Lyrica (pregabalin; Pfizer) 161 Physicians rated Lyrica relatively highly in terms of duration of action 163 Actiq (oral transmucosal fentanyl; Cephalon) 165 Actiq is the more widely recognized of Cephalon’s two fentanyl products 166 Contrary to clinical trial data, physicians rated Actiq’s onset of action on a par with Fentora 167 Fentora (fentanyl buccal tablet; Cephalon) 169 Fentora’s ratings for convenience of administration marginally outperform Actiq 170 CHAPTER 9 IMPROVING TREATMENT OUTCOMES AND UNMET NEEDS 172 Effectiveness of available prescription pain medicines 173 Surveyed physicians believe that there is room for improvement in the effectiveness of available mediations for cancer pain 173 Physicians are least satisfied with current treatments for neuropathic cancer pain 174 Unmet needs 175 Non-clinical unmet needs 176 Physician education represents the most pressing unmet need in the management of cancer pain 176 Clinical unmet needs: neuropathic cancer pain 179 Improved efficacy 179 Improved side-effect profile 181 Reduced time to onset of action 181 Fewer drug-drug interactions 182 Reduction in pill burden 182 Clinical unmet needs: non-neuropathic cancer pain 182 Reduction in opioid-related adverse events 183 Reduction in the abuse and overdosing potential of opioids 184 Clinical unmet needs: breakthrough cancer pain 184 Reduction in opioid-related adverse events 185 Need for an analgesic that acts rapidly, predictably and just for the duration of a breakthrough pain episode 186 Quick, simple and safe drug administration 187 Improved convenience, cost and safety of patient-controlled analgesia 188 Need for standardized diagnosis and assessment tools for breakthrough pain 189 BIBLIOGRAPHY 190 Datamonitor reports 190 Posters 190 Books 190 Journal papers 191 Websites 204 APPENDIX A 210 Physician research methodology 210 Physician sample breakdown 210 US 210 Japan 212 France 213 Germany 214 Italy 215 Spain 216 UK 217 Contributing experts 218 APPENDIX B 219 The survey questionnaire 219 Screener questions 219 Section 1 – Prevalence of cancer pain 221 Section 2 – Referral patterns 222 Section 3 – Treatment of chronic neuropathic cancer pain 224 Section 4 – Treatment of chronic non-neuropathic cancer pain 233 Section 5 – Treatment of breakthrough cancer pain 236 Section 6 – Prescribing influences and product profiles 238 Section 7 – Treatment outcomes 241 Demographics 242 About Datamonitor 244 About Datamonitor Healthcare 244 About the Central Nervous System pharmaceutical analysis team 245 Disclaimer 247 [Inhaltsverzeichnis ausblenden] |
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