Oral Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

Pain in cancer survivors (#68)

Paul Glare 1
  1. Pain Medicine, University of Sydney, Northern Clinical School, St Leonards, NSW, Australia

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:

  • Clinicians should screen for pain at each patient encounter
  • Survivors with new onset pain should be evaluated for disease recurrence/second malignancies
  • The goal of treatment is improved function as well as pain relief
  • Non-opioid analgesics/coanalgesics are first line pharmacotherapy
  • A trial of opioids may be warranted - in carefully selected patients not responding to more conservative management
  • If opioids are no longer warranted, they should be carefully tapered and ceased
  • Referral to other health professionals to provide comprehensive pain management care should be considered for patients with complex needs

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.  

  1. Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E. 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] J Clin Oncol. 2016 Jul 25. pii: JCO685206. [Epub ahead of print]