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.

Keywords:

• cancer pain
• pain management
• precision medicine
• digital medicine

Acknowledgments

The authors would like to thank Ashley Symons, Ph.D. for draft preparation and editorial assistance on this manuscript.

Abbreviations

BTcP, breakthrough cancer pain; NSAID, non-steroidal anti-inflammatory drug; QoL, quality of life; ROO, rapid-onset opioid.

Data Sharing Statement

The complete dataset is available from the corresponding author upon request.

Ethics Approval and Informed Consent

The study was exempt from informed consent as an anonymized survey. Ethics approval was not required as per Italian regulations.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work”.

Disclosure

PB's is affiliated with both Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia and Unit Department Medical Oncology, ASST Spedali Civili di Brescia, Italy. PB also has received support from Merck Serono, Bristol-Myers Squibb, Hinn, Helsinn, and GlaxoSmithKline, Sanofi, Merck Sharp & Dohme, Sun Pharma, Angelini Pharma, and Molteni Farmaceutici. AA reports grants from Bristol-Myers Squibb, Angelini Pharma, Accord, and Kyowa Kirin. GA reports grants from Novartis. JG reports funding from Molteni Farmaceutici. ML reports funding from Eli Lilly. SS reports funding from Ipsen, Novartis, MSD and BMS. FC, RG, AM, and LP have no conflicts of interest to declare. The authors report no other conflicts of interest in this work.