The purpose of the Instanyl study is to learn how much doctors know and understand about Instanyl® before and after they receive updated educational information, including the risks of its unapproved use. In this study, the doctors will complete two surveys: one three months before they receive the updated educational information, and one about six months after they receive this information. They will answer questions about their prescribing behavior plus their knowledge of Instanyl® including any risks.

This is a non-interventional, observational, cross-sectional study of prescribers of Instanyl®.

This study will assess the prescribers' awareness of the updated EMs and changes in prescribers' knowledge and understanding of the key information contained in the updated EMs. The study will enroll approximately 259 prescribers. The first survey (pre-EM survey) will be conducted three months before the distribution of updated EMs, second survey (post-EM survey) will be conducted six months following the distribution of updated EMs.

The data will be collected, through a self-administered web-based questionnaire. All participants will be enrolled in a single observational group:

• Prescriber of Instanyl®

This multi-center study will be conducted in France, the Netherlands, and Poland. The overall duration of the study will be approximately 22 months.

Inclusion Criteria:

1. Specialists of any of those medical specialties targeted for the EMs as agreed with each national competent authority. The foreseen specialties include the following (subject to changes after the EM distribution plan is completed and agreed with national competent authorities):

   • Oncologists and oncoradiologists
   • Anaesthesiologists
   • Pain management prescribers
   • Palliative care prescribers
   • Internal medicine prescribers
   • General practitioner (GPs)
   • Other specialties may be locally included such as hematology. Current and potential prescribers may vary between country; thus, some countries may have modified lists of target specialties.

2. Physicians who have prescribed Instanyl® in the past 12 months (pre-EM survey) or since the updated EMs (post-EM survey) and who intend to prescribe Instanyl® in the following months after each survey.

Exclusion Criteria:

1. Physicians who may have a conflict of interest (that is, prescribers employed by regulatory bodies, pharmaceutical industries).
2. Inactive or retired prescribers.
3. Physicians who did not prescribe Instanyl® in the past 12 months (pre-EM survey) or since the updated EMs are distributed (post-EM survey) and do not foresee treating a participants with Instanyl® in the following 12 months, regardless of whether they have prescribed Instanyl® before.

Prescribers of Instanyl® will be assessed before and after the distribution of the updated EMs.

Takeda provides access to the de-identified individual participant data (IPD) for eligible studies to aid qualified researchers in addressing legitimate scientific objectives (Takeda's data sharing commitment is available on https://clinicaltrials.takeda.com/takedas-commitment?commitment=5). These IPDs will be provided in a secure research environment following approval of a data sharing request, and under the terms of a data sharing agreement.

IPD from eligible studies will be shared with qualified researchers according to the criteria and process described on https://vivli.org/ourmember/takeda/. For approved requests, the researchers will be provided access to anonymized data (to respect patient privacy in line with applicable laws and regulations) and with information necessary to address the research objectives under the terms of a data sharing agreement.