According to the NSW Cancer Plan 2016, cancer survivorship refers to the process of living with, through, and beyond, cancer. Beginning at diagnosis, it includes people continuing treatment and even encompasses patients on palliative care/hospice. Pain in survivors broadly defined may be due to disease, anticancer treatments, debilitation or unrelated comorbidities. It is estimated 5-10% of disease-free survivors experience chronic, severe post-treatment pain. It rarely occurs in isolation: patients often have other physical symptoms and are anxious and depressed. ASCO recently released a Clinical Practice Guideline on the Management of Chronic Pain in Survivors of Adult Cancer.1 Due to the paucity of high quality evidence, many recommendations were based on expert consensus. They include:
A key question going forward is whether post-treatment pain in a long-term survivor should be conceptualized as cancer pain or chronic non-malignant pain. Many survivors have both. Data from ePPOC are beginning to suggest that Australian cancer survivors have the same maladaptive psychological coping as other chronic pain patients, indicating more of a role for non-pharmacological interventions. A high level of collaboration between oncology, palliative care and pain services is needed to optimize outcomes for cancer survivor pain.