Cancer pain during an epidemic and a pandemic

Abstract

Purpose of review As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge. Recent findings Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression. Summary Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.

Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits

“… 110 , 199 , 200 Additional efforts should be directed at early identification of patients at risk of addiction 201 and at raising patient awareness of the need to avoid sharing medicines, to keep opioids under lock and key, and to dispose of expired or unused medicines. 72 , 111 , 201 – 203 To ensure effective knowledge transfer between all healthcare professionals caring for a patient who may be at higher risk of dependence, the diffusion of personal health electronic records could be decisive. 185 …”

“… 66 , 70 Therapies should be individualized based on patient status, comorbidities, drug toxicity profile, prior experience, preferred and indicated route of administration, and formulation. 59 , 71 , 72 …”

Insomnia among Cancer Patients in the Real World: Optimising Treatments and Tailored Therapies

“…In addition, pain provoked by the disease or its surgical or pharmacological treatment may easily impact sleep quality [2,26]. Pain is, in fact, one of the most disabling symptoms for the cancer patient, affecting more than 50% of patients at any stage of the disease and more than two-thirds of those with metastatic or advanced disease [27]. Numerous studies have revealed that people with severe or chronic pain have a higher prevalence of depressive symptoms and insomnia [2].…”

Cancer Patients with Chronic Pain and Their Caregivers during COVID-19: A Descriptive Study

“…Therefore, effective chronic pain management is crucial in many domains both at the patient- and the organizational-level and should be integrated in a comprehensive assessment and symptom control performed by the healthcare professionals [ 1 , 12 , 13 , 14 ]. To achieve an optimal pain management for cancer patients, standard care recommends the combination of pharmacological measures (e.g., opioid medication) with physical therapy (e.g., exercise, acupuncture, massage, and transcutaneous electric nerve stimulation), psychosocial therapy (e.g., mindfulness, supportive therapy), and herbal supplementation [ 12 , 15 , 16 , 17 ].…”

“…The sanitary measures to control the COVID-19 dissemination led to a sustained reduction in the number of cancer patients diagnosed, referred, and treated [ 29 ], and altogether to a worst chronic pain assessment and control than before [ 14 ].…”