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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sequential, coordinated efforts\u2014consensus building, measurement development, targeted research, co-designed implementation supports and supply chain planning\u2014are required to advance equitable, evidence-based BTcP care in Australia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-10518-z","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T02:43:03Z","timestamp":1773196983000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Breakthrough cancer pain management (BTcP)\u2014gap analysis of the current Australian landscape"],"prefix":"10.1007","volume":"34","author":[{"given":"Wei","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Nagla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron Bak Ong","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Magann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Lovell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Mantle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Reed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghauri","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron K.","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Pene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Allcroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory B.","family":"Crawford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Michael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"10518_CR1","doi-asserted-by":"publisher","unstructured":"Snijders RAH, Brom L, Theunissen M, van den Beuken- Everdingen MHJ (2023) Update on prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis. cancers (Basel). https:\/\/doi.org\/10.3390\/cancers15030591","DOI":"10.3390\/cancers15030591"},{"key":"10518_CR2","doi-asserted-by":"publisher","first-page":"4149","DOI":"10.1200\/JCO.2014.56.0383","volume":"32","author":"MT Greco","year":"2014","unstructured":"Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. 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ABW and WL received honoraria from Menarini for the roundtable meetings and related conference sponsorship. CP and GA received honorarium from Menarini for this roundtable discussion. NM was previously on the Advisory Board of Menarini Australia Ltd and Received Honorariums from Menarini Australia Ltd. Menarini Australia Ltd assisted with platform setup for the roundtable and reimbursed some participants\u2019 travel and time; they had no role in participant selection, concept design, data analysis, or manuscript preparation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All participants provided written informed consent to participate in the roundtable discussions.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All participants provided written informed consent to have the results published.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"In line with the National Statement on Ethical Conduct in Human Research (2023) by the National Health and Medical Research Council, the research did not require ethics approval as it was conducted using publicly available literature [\n                      \n                      ].","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"301"}}