What to Do and What Not to Do in the Management of Cancer Pain: A Physician Survey and Expert Recommendations

Abstract

Background Despite the prevalence of pain among patients with cancer and the availability of pertinent guidelines, the clinical management of oncological pain is decisively insufficient. To address this issue, we evaluated current trends in clinical practice and subsequently generated a list of ten corrective actions—five things to do and five things not to do—for the diagnosis, management, and monitoring of cancer pain. Methods The survey included 18 questions about clinical practice surrounding background pain and breakthrough cancer pain (BTcP). Survey questions were developed by a scientific board of 10 physician experts and communicated via email to an expanded panel of physicians in Italy. Responses were tabulated descriptively for analysis. Results Of 51 invited physicians, 32 (63%) provided complete survey responses. The responses revealed several incongruencies with current guideline recommendations: physicians did not always diagnose or monitor pain using diagnostically validated or disease-specific instruments; frequently based clinical decision-making on time availability or convenience; and pharmacological therapy was often inappropriate (eg, prescribing NSAIDs or corticosteroids for BTcP). The list of corrective actions generated by the scientific board favored a guideline-oriented approach that systematically characterizes oncological pain and implements treatment based on pain characteristics (eg, fast-acting transmucosal opioids for BTcP) and evidence-based recommendations. Conclusion Oncologists require better education and training about the diagnosis, treatment, and monitoring of oncological pain. Physicians should be aware of current guideline recommendations as well as available pharmacological tools for BTcP.

Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

“…Integration with patient-reported outcomes, such as the Oral Mucositis Daily Questionnaire 109 or the Patient-Reported Oral Mucositis Symptom Scale, 110 becomes critical for improving the accuracy of clinical evaluation. 5 The Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology offer specific guidelines for the treatment of oral mucositis. 101 Primarily, oral administration of systemic opioids is recommended to treat pain, whilst intravenous morphine is the preferred parental route for patients who cannot swallow.…”

“…Cancer pain is therefore a common symptom that has a notable impact on both health-related quality of life (QoL) and adherence to antitumoural treatment. [2][3][4][5] A modern, multidisciplinary approach to cancer-related pain would ensure better health outcomes and an improved QoL for patients with cancer. [6][7][8][9]…”

“…Cancer pain is therefore a common symptom that has a notable impact on both health-related quality of life (QoL) and adherence to antitumoural treatment. 2 – 5 …”

High-rate breakthrough cancer pain and tumour characteristics – literature review and case series

“…It is therefore highly predictable and is often amenable to preventive treatment 22 and administration of rescue medications. 23 Temporary exacerbations of cancer pain despite adequate baseline pain control with strong opioids make the assessment and management of cancer pain particularly critical. 24 The high intensity of sudden pain along with its unpredictability, rapid onset and a…”

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

“…3,8,9 Cancer-related pain is a multidimensional symptom that includes physical, psychosocial, emotional and spiritual components. 10,11 Poor cancer pain management contributes to worsening quality of life (QOL), [12][13][14][15][16] can influence adherence to antitumor treatment, 17 has a significant impact on the psychological aspects of life and emotional well-being, 18,19 and worsens fatigue, sleep disorders, nutritional status, anxiety, depression and social withdrawal. [20][21][22][23][24][25] Many patients with cancer require emergency department consultation for acute oncological pain, and a high percentage are admitted to hospital to manage pain, thus increasing healthcare costs.…”