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Assessing cancer pain—the first step toward improving patients’ quality of life

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Abstract

Purpose

Numerous studies on cancer patients have shown that cancer pain still remains underestimated, poorly assessed, and under-treated. Pain relief should be considered as early as possible within personalized care and as an integral part of quality healthcare in many countries. Nevertheless, personalized care is still insufficiently taken into consideration, partly due to improper or incomplete assessment of cancer pain. The objective of this article is to propose a practical approach to this complex assessment, as the first step to improving patients’ quality of life.

Methods

Critical reflection based on literature analysis and clinical practice.

Results

Assessment of cancer pain means evaluating the pain intensity over time, the dimensions of pain (sensory-discriminative, cognitive, emotional, and behavioral), the pathophysiological nature of pain (neuropathic, nociceptive, and nociplastic), the etiology, and the patient’s perception (diffuse, localized, global). Cancer patients may have simple or multiple forms of pain (mixed, overlapped, combined, and associated). Furthermore, with the use of new specific therapies, the symptomatology of pain is also changing, and certain cancers are becoming chronic. Thus, cancer pain is an archetype of multimorphic pain, and its dynamic assessments (regular and repeated) require a multimodal and targeted approach in order to offer personalized pain management. Multimodal pain treatment must be adapted to the elements that disrupt cancer pain, to the patient’s cancer and to the specific treatments.

Conclusions

The dynamic assessments of pain demand the simplest, and the most complete possible procedure, to avoid feasibility problems or self-/hetero-assessment excesses that might lead to less precise and less reliable results. Multimodal and interdisciplinary approaches are being developed, making it possible to optimize cancer pain management.

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Acknowledgments

This article was funded by Kyowa Kirin. Support was provided by Xavier Amores, M.D. and Viorica Braniste, M.D. & Ph.D. (Kyowa Kirin), and Robert Campos Oriola, Ph.D, and Marie-Odile Barbaza, MD, (Auxesia) for manuscript preparation.

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Authors and Affiliations

  1. Anaesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France

    Christian Minello

  2. Pain Management Unit, Hospital Saint-Louis, Paris, France

    Brigitte George

  3. Pain Management Unit, Mutualist Clinic of la Porte-de-l’Orient, Lorient, France

    Gilles Allano

  4. Pain Management Center, Grenoble-Alpes University Hospital, Grenoble, France

    Caroline Maindet

  5. Department of Supportive Care, Institut Curie, PSL Research University, Paris, France

    Alexis Burnod

  6. Oncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes, France

    Antoine Lemaire

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  1. Christian Minello
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Correspondence to Antoine Lemaire.

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Christian Minello reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Takeda; and non-financial support from Kyowa Kirin, Mundi Pharma, Mylan Pharma and Grunenthal, outside the submitted work. Brigitte George reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Mundipharma; non-financial support from Grunenthal and Kyowa Kirin, outside the submitted work; and participation to a clinical study without honoraria from Bouchara. Gilles Allano reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Grunenthal, Mundipharma and Medtronic; and non-financial support from Kyowa Kirin, outside the submitted work. Caroline Maindet reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Mundipharma; and non-financial support from Kyowa Kirin, Grunenthal, Hospira, Takeda, and Janssen Cilag, outside the submitted work. Alexis Burnod reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; non-financial support from Kyowa Kirin, outside the submitted work. Antoine Lemaire reports non-financial support from Kyowa Kirin France, during the conduct of the submitted work; personal fees and non-financial support from Kyowa Kirin International, Mundi Pharma, Grunenthal and Takeda; personal fees from Mylan; and non-financial support from Kyowa Kirin France, Archimèdes Pharma, Teva, Prostrakan, outside the submitted work.

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Minello, C., George, B., Allano, G. et al. Assessing cancer pain—the first step toward improving patients’ quality of life. Support Care Cancer 27, 3095–3104 (2019). https://doi.org/10.1007/s00520-019-04825-x

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