Judith A Paice1, Russell Portenoy1, Christina Lacchetti1, Toby Campbell1, Andrea Cheville1, Marc Citron1, Louis S Constine1, Andrea Cooper1, Paul Glare1, Frank Keefe1, Lakshmi Koyyalagunta1, Michael Levy1, Christine Miaskowski1, Shirley Otis-Green1, Paul Sloan1, Eduardo Bruera1. 1. Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY.
Abstract
PURPOSE: To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. METHODS: An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. RESULTS: A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. RECOMMENDATIONS: Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.
PURPOSE: To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. METHODS: An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. RESULTS: A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. RECOMMENDATIONS: Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.
Authors: Qiuling Shi; Ju-Whei Lee; Xin Shelley Wang; Michael J Fisch; Victor T Chang; Lynne Wagner; Charles S Cleeland Journal: JCO Oncol Pract Date: 2020-05-05