Cancer Management and Research (Jun 2021)
What to Do and What Not to Do in the Management of Cancer Pain: A Physician Survey and Expert Recommendations
Abstract
Paolo Bossi,1 Andrea Antonuzzo,2 Grazia Armento,3 Francesca Consoli,1 Jacopo Giuliani,4 Raffaele Giusti,5 Maurizio Lucchesi,6 Aurora Mirabile,7 Loredana Palermo,8 Sarah Scagliarini9 1Department of Medical Oncology, ASST-Spedali Civili, Brescia, Italy; 2Medical Oncology Unit 1 SSN, Oncology Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; 3Department of Medical Oncology, Campus Bio-Medico University Hospital, Rome, Italy; 4Unit Department Medical Oncology, Mater Salutis, Hospital, Legnago, Italy; 5Unit Department Medical Oncology, Sant ‘Andrea University Hospital, Rome, Italy; 6Pneumology Unit - Thoracic Oncology Service, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; 7Department of Oncology, San Raffaele University Hospital, Milan, Italy; 8Unit Department Medical Oncology, IRCCS Giovanni Paolo, Bari, Italy; 9Unit Department Medical Oncology, AORN Cardarelli, Napoli, ItalyCorrespondence: Paolo BossiDepartment of Medical Oncology, ASST-Spedali Civili, Brescia, 1, Brescia, 25123, ItalyTel +39 0303998969Fax +39 0303995072Email [email protected]: 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
