Cancer Pain Management
Pain is a common symptom experienced by patients with cancer, from diagnosis through survivorship. Whether as a result of disease or disease-related treatment, pain causes significant physical and psychosocial burdens. A uniquely personal experience, pain markedly affects the quality of an individual’s life, increases vulnerability in an already vulnerable population, and engenders dependence on healthcare providers for access to adequate pain management. Cancer pain frequently is assessed and treated inadequately (American Pain Society, 2005; National Comprehensive Cancer Network [NCCN], 2015).
Safe and effective pain management may include pharmacologic and nonpharmacologic measures. Because oncology nurses embrace holistic care and have sustained contact with patients throughout the continuum of cancer care, they are in a position to identify undertreated and untreated cancer pain and advocate for its relief. As members of interdisciplinary teams involved in practice, education, administration, and research, oncology nurses are in a pivotal position to improve cancer pain management.
NCCN (2015) reported that increasing evidence suggests that improved survival outcomes and quality of life are linked to adequate symptom management that is collaboratively achieved with patient engagement, including the use of evidence-based guidelines to monitor and individualize pain control measures.
It is the position of ONS that
- Cancer pain prevention and treatment are essential elements of quality cancer care throughout all phases of the cancer care continuum.
- All people with cancer have a right to optimal pain relief that includes culturally relevant and sensitive pain education, assessment, and management.
- All people with pain must be recognized, with special emphasis placed on the populations known to be at high risk for suboptimal pain management (i.e., children; older adults; minority populations; women; people with a history of previous or active substance abuse; those with limited financial resources, social support systems, or access to health care; individuals with cognitive or psychosocial impairment; and those with previous histories of analgesic allergies or metabolic alterations).
- The public, people with cancer, and significant others must be educated about the right to safe and effective cancer pain management.
- The use of combination of opioid therapy constitutes the standard of care for patients with cancer, particularly those with advanced disease or at end of life.
- Because of the complex variation at the genomic level, some cancers may be histologically similar but will not respond to a single analgesic type or management protocol sufficient to provide pain relief, requiring complex management unique to this patient population and requiring availability of patient-controlled analgesia, sustained-release products, and short-acting opiates.
- Types of pain management and routes of administration are determined based on many patient-specific factors, requiring access to oral, transdermal, rectal, sublingual, parenteral, intramuscular, and intrathecal administration routes to provide combination therapy that is critical to effective pain management.
- Individual levels of tolerance to opioid management may be distinctly unique from opioid management expectations of pain not related to cancer because of pain intensity, characteristics, duration, and disease-specific factors.
- Placebos should not be used to assess or manage cancer pain, determine whether the pain is “real,” or diagnose psychological symptoms associated with pain, such as anxiety.
- Comprehensive cancer pain management is a multidisciplinary and collaborative effort that must include ongoing individual assessment, planning, intervention, and evaluation of pain and pain relief. Comprehensive pain management addresses physical, psychological, spiritual, and sociocultural effects of unrelieved pain.
- Healthcare professionals, particularly nurses, pharmacists, and physicians, are accountable to manage cancer pain effectively.
- Healthcare providers must adopt and prioritize pain as the “fifth vital sign” and standardize pain assessment throughout their workplaces.
- Professional and postgraduate cancer care curricula for nurses and other healthcare providers must include didactic information and clinical experiences related to cancer pain and its management.
- All professionals caring for patients with cancer have an ethical responsibility to acquire and use current knowledge and skills to assess cancer pain and implement evidence-based pain management guidelines.
- Ongoing continuing education regarding cancer pain and its management is essential for all oncology nurses.
- The conduct of cancer pain research and the use of evidence-based findings in education and practice are priorities for nurses and the Oncology Nursing Society.
- Oncology nurses must actively involve all patients, as well as their family caregivers and significant others, in the development of a pain management plan of care and encourage open communication for the reporting of pain at all times.
- Oncology nurses must adopt pain management as a priority in continuous quality improvement initiatives.
- Oncology nurses have a professional obligation to ensure that institutional and clinical standards for cancer pain management are adopted.
- Healthcare systems and clinicians providing care to patients with cancer are responsible for adopting and monitoring institutional and clinical guidelines for cancer pain management and symptoms related to its treatment. Healthcare systems must establish mechanisms for continuous evaluation of pain outcomes in patients at risk for cancer pain.
- Healthcare facilities must establish minimum standards for clinicians’ pain assessment and technical skills (e.g., epidural and patient-controlled analgesia pump management). Organizations and healthcare facilities must adopt and support the use of evidence-based pharmacologic and nonpharmacologic interventions and establish minimum standards for competency in their use.
- Regulatory, legislative, economic, and other barriers to effective cancer pain management must be eliminated.
Approved by the ONS Board of Directors, April 1998; revised November 2000, June 2002, October 2004, October 2006, January 2010, January 2013, January 2014, January 2015, January 2016.
American Pain Society. (2005). Guideline for the management of cancer pain in adults and children. Glenview, IL: Author.
National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines: Adult cancer pain [v.2.2015]. Fort Washington, PA: Author. Retrieved on October 23, 2014 at http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf