Understanding cancer pain to improve its management: a conversation with Professor Andrew Davies
February 4th is the day dedicated worldwide to cancer awareness. Every year, the World Cancer Day promotes education, and actions against cancer to make prevention, treatment and care equitable for all.1
Cancer-related complications and comorbidities add a highly significant burden on patients, negatively affecting many aspects of their quality of life such as nutritional status, physical functioning, and mental health.2
In particular, pain continues to be a prevalent symptom in patients with cancer, with prevalence rates of around 39.3% after curative treatment, 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease.3
Cancer Pain is one of the major points of attention for Angelini Pharma whose commitment is not limited to the control of this symptom, but also aimed at preserving patients’ well-being in their everyday life, including Mental Health
In this interview Andrew Davies, Professor of Palliative Medicine at the Trinity College of Dublin and President of the Multinational Association of Supportive Care, answers some questions about cancer pain, giving tips to better understand, manage and communicate it.
The presence and severity of pain have a remarkable impact on the quality of life, as well as on the evolution of the disease. Poor pain control is also associated with more psychological distress and decreased social activities.4
1. Doctor Davies, is pain a common symptom among cancer patients?
Pain is a common symptom in patients with cancer and it can occur at any stage of the disease. It is often present at the diagnosis, according to the type of cancer. In the case of advanced cancer, up to 80% of patients can experience pain. Despite the fact that it is common, cancer pain is often very manageable, so patients do not need to suffer with pain.
2. What are the consequences of pain on cancer patients and their caregivers?
Pain can have a huge impact on patients’ lives. Untreated, under controlled pain can have a number of complications. Often, patients with pain are relatively immobile. Pain can interfere with sleep and can affect people’s mood. Patients with pain may need to visit their doctors and the hospitals more often. So, their caregivers have to do more for them, and they may not be able to work. This is why it is important to manage pain properly, because all of these complications are potentially preventable.
3. Is there a link between psychological problems and pain in cancer patients?
There is an association between pain and psychological problems, particularly anxiety and depression. The issue is that patients who do have depression, find it more difficult to self-manage their pain, so there’s almost a vicious circle there. Good management of pain can help prevent the development of psychological problems and other complications. Furthermore, often we use similar treatments to treat depression and pain. So, it is important to monitor people’s psychological state as well as monitor their pain. Fortunately, today there are several ways to manage cancer pain, depending on the type of pain the patient feels and its causes.
4. Which different kinds of pain can cancer patients experience?
Cancer patients can experience a variety of different types of pain. They can experience pain due to cancer itself, pain due to the treatment and, of course, the pain everybody else experiences. So, it is very important to differentiate between different types of pain, because also the treatment is very different. It is important that patients are properly assessed to find exactly what is causing their pain, so that they can be prescribed the right treatment, because not all the treatments will work for all the pains.
5. What are the options for managing cancer pain?
Different things will work in different types of pain and in different patients. If pain is due to cancer, then, often, treating the cancer can also improve pain. However, sometimes, even though the treatment is very effective, patients continue to feel pain. In this case, there are many non-pharmacological interventions that can be very helpful, such as heat and cold interventions, TENS (Transcutaneous Electrical Nerve Stimulation) machine or acupuncture, and then there is a whole range of drugs that might be useful. Bone issues may benefit from interventions from occupational therapists, physiotherapists, or orthopedic surgeries. Some people will need pain interventions from anesthetists, like nerve blocks or infusions of local anesthetic. So, it is very important to target all of the interventions to the individual patient and the individual pain. Patient and caregivers should play an active role in cancer pain management.5
6. How can patients communicate with their doctor to help them to manage cancer pain?
It is important that patients report their pain and any changes. It is also fundamental that they monitor how effective the pain relief is and whether they are developing side effects. All this information will help doctors and nurses to decide whether to continue with that treatment, increase the dose of drug or change it. It is important that we give people the right treatment for the right pain. So, it is vital for the patients and for their caregivers to do liaise with doctors and nurses and inform them about how the treatments is working.
7. Which is the role of caregivers in pain treatment?
Caregivers, in particular family caregivers, are very important in managing patient’s pain. It is essential that they encourage the patients to take their medication but also to report how effective the treatment is, and whether or not it is causing side effects. Caregivers can also help with non-pharmacological interventions, so when patients are having episodes of breakthrough pain, they can support them by using distraction techniques, helping them to relax, massaging the patient, if that is helpful. They can also give emotional support and help the patients communicating with their doctors and nurses.
8. In your opinion, what is needed to improve cancer pain patients’ assistance?
We have lots of ways of managing cancer pain but there are still issues in terms of managing many cancer patients’ pain. I think part of the problem is that we do not continually monitor patients’ pain, and so it is important, if the pain is not controlled or the interventions are causing side effects, that the patients and their caregivers contact the doctors/nurses looking after them and inform them. It is necessary, as healthcare professionals, that we educate and reassure the patients and their family about the safety of these interventions, and how to use them properly. It is also crucial, if a patient’s pain is not being controlled and the doctors/nurses looking after them do not have a solution to that problem, to refer on to a pain or a palliative care specialist. I would say to all patients: there is something you can do to improve your pain, if not get rid of it.
Click here to watch the interview.
References
1. https://www.worldcancerday.org/about-us Last Accessed November 2021
2. White Paper. The impact of cancer-related comorbidities on patient treatment, treatment efficacy, survivorship, and quality of life.
3. van den Beuken-van Everdingen MH, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals of
oncology: official journal of the European Society for Medical Oncology. Sep; 2007 18(9):1437– 1449.
4. Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin. 2018 May;68(3):182-196.
5. Schumacher KL, et al. Putting cancer pain management regimens into practice at home. J Pain Symptom Manage. 2002 May;23(5):369-82.