ASCO Develops First-Ever Guidelines for Pain Management in Cancer Survivors

Charles Bankhead

September 2016, Vol 7, No 8 - Cancer Pain


Every patient with cancer and cancer survivors should undergo screening for pain at each follow-up visit, and clinicians should individualize the recommendations for intervention as indicated by each patient’s self-reported pain, according to the first-ever clinical guidelines for managing pain in cancer survivors recently published by a panel of experts convened by the American Society of Clinical Oncology (ASCO).1

The guideline covers screening for cancer-related pain; use of pharmacologic and nonpharmacologic interventions, including medical marijuana; and assessment of adverse effects. This first guideline related to pain management evolved from the recognition of unmet need among patients with cancer and cancer survivors resulting from the growing population of cancer survivors, which is currently estimated at 14 million.

“Many oncologists and primary care physicians are not trained to recognize or treat long-term pain associated with cancer. This guideline will help clinicians identify pain early and develop comprehensive treatment plans, using a broad range of approaches,” said ASCO panel Co-chair Judith A. Paice, PhD, RN, research professor at Northwestern University in Chicago, in a press release statement.

An estimated 40% of cancer survivors have persistent disease- or treatment-related pain, which can adversely affect quality of life.2 Existing guidelines on the management of cancer-related pain have focused primarily on the relief of acute pain or pain associated with advanced disease. The ASCO guideline is the first developed specifically for the management of pain in cancer survivors.

The guideline panel developed a total of 21 recommendations, consisting of 4 recommendations related to patient screening and assessment; 11 recommendations involving options for treatment and care; and 6 recommendations addressing risk assessment, mitigation, and universal precautions related to opioid prescribing and use of opioids by patients and survivors.

Key ASCO recommendations for pain management in cancer survivors include:

  • Screening for pain at each patient encounter, including evaluation for recurrent disease, second malignancy, or late-onset treatment effects
  • Determining the need for other health professionals to provide comprehensive pain management to care for patients with complex needs
  • Considering nonpharmacologic interventions, interventional therapies, and psychologic approaches to pain management
  • Using nonopioid analgesics and adjuvant analgesics (selected antidepressants and anticonvulsants) to relieve chronic pain or to improve physical function
  • Using a trial of opioids in carefully selected patients who continue to have pain with more conservative management strategies
  • Incorporating a universal precautions approach to minimize abuse, addiction, and adverse consequences of opioid abuse.
“This guideline outlines precautions that help ensure cancer survivors with persistent pain use opioids safely and effectively, while limiting access to those who are struggling with addiction,” Dr Paice said in the statement.

The multidisciplinary panel that developed the guideline included specialists representing medical oncology, hematology/oncology, palliative care, pain medicine, hospice care, radiation oncology, social work, symptom management research, rehabilitation, psychology, and anesthesiology, as well as a patient representation. The guidelines reflect the cumulative evidence the panel culled from a review of 63 studies that were published between 1996 and 2015.




References

  1. Paice JA, Portenoy R, Lacchetti C, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016 Jul 25. Epub ahead of print.
  2. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, et al. Update on prevalence of pain in patients with cancer: systematic review and met­a-analysis. J Pain Symptom Manage. 2016;51:1070-1090.e9.