Purpose Adequate cancer pain management (CPM) is challenging in resource-limited settings, where current international guideline recommendations are difficult to implement owing to constraints such as inadequate availability and accessibility of opioids, limited awareness of appropriate opioid use among patients and clinicians, and lack of guidance on how to translate the best evidence into clinical practice. The multinational and multidisciplinary CAncer Pain managEment in Resource-limited settings (CAPER) Working Group proposes a two-step initiative to bridge clinical practice gaps in CPM in resource-limited settings. Methods A thorough review of the literature, a steering committee meeting in February 2017, and post-meeting teleconference discussions contributed to the development of this initiative. As a first step, we developed practical evidence-based CPM algorithms to support healthcare providers (HCPs) in tailoring treatment according to availability of and access to resources. The second part of the initiative proposes a framework to support an effective implementation of the CPM algorithms that includes an educational program, a pilot implementation, and an advocacy plan. Results We developed CPM algorithms for first-line use, breakthrough cancer pain, opioid rotation, and refractory cancer pain based on the National Comprehensive Cancer Network guidelines and expert consensus. Our proposed educational program emphasizes the practical elements and illustrates how HCPs can provide optimal CPM according to evidence-based guidelines despite varied resource limitations. Pilot studies are proposed to demonstrate the effectiveness of the algorithms and the educational program, as well as for providing evidence to support a draft advocacy document, to lobby policymakers to improve availability and accessibility of analgesics in resource-limited settings. Conclusions These practical evidence-informed algorithms and the implementation framework represent the first multinational step towards achieving optimal CPM in resource-limited settings. Electronic supplementary material The online version of this article (10.1007/s00520-018-4471-z) contains supplementary material, which is available to authorized users.

Background: Phlebitis is a very common side effect of continuous intravenous infusion of 5-fluorouracil via the peripheral veins. We evaluated the preventive effects of topical steroid application on fluorouracil-induced phlebitis in a randomized, double-blind, placebo-controlled trial. Methods: Patients were randomly selected to receive either petroleum jelly plus steroid ointment (steroid group) or petroleum jelly ointment only (placebo group) at the Kyoto University Hospital. The main eligibility criteria were as follows: planned to undergo at least 1 course of cisplatin and 5-fluorouracil (CF) therapy; planned to receive anticancer drugs via the peripheral veins; not requiring steroid ointment on the arm (e.g., dermatitis treatment); and provided signed informed consent. Patients applied the ointments twice daily (morning and evening) during CF therapy. We assessed pigmentation and induration 24 hours and 1 month after CF therapy. To assess the effectiveness of petroleum jelly itself, the effects of the placebo and historical control (n ¼ 14, no ointment) were also compared. The Fisher's exact test (incidence) and logrank test (time to events) were used for statistical analysis. Results: We randomly assigned 46 patients to the steroid and placebo groups (n ¼ 23 each). All patients applied their respective ointments. Forty-five subjects were included in the analysis, excluding 1 patient in the placebo group who applied the steroid ointment due to extravasation. The incidence of clinically significant phlebitis was lower in the steroid than in the placebo group (pigmentation: 24 hours, 0% vs. 22%, P ¼ 0.05; 1 month, 18% vs. 48%, P ¼ 0.06; induration: 24 hours, 0% vs. 0%, P ¼ 1.00; 1 month, 5% vs. 39%, P ¼ 0.01). Pigmentation occurred earlier in the placebo group (placebo, median 6 days; steroid, median 13.5 days; P ¼ 0.363). The incidence rates of phlebitis were significantly lower in the placebo group than in the historical control (52% vs. 86%; P ¼ 0.04).