Journal of Cancer Survivorship

, Volume 2, Issue 1, pp 65–71 | Cite as

Barriers to pain assessment and management in cancer survivorship

  • Virginia Sun
  • Tami Borneman
  • Barbara Piper
  • Marianna Koczywas
  • Betty Ferrell
Article

Abstract

Introduction

Healthcare providers frequently lack the knowledge and skills to provide optimal pain management for cancer survivors. Scientific evidence and clinical guidelines are lacking in the management of chronic, persistent pain in survivors. The purpose of this article is to describe pain-related issues of cancer survivors using case presentations of selected patients enrolled in a randomized trial to eliminate barriers to pain management.

Materials and methods

Case presentations were selected from a National Cancer Institute-funded study that utilizes patient and professional educational content derived from the clinical guidelines of the National Comprehensive Cancer Network. Case presentation criteria included a pain rating of ≥6 and diagnosis of Stage I, II, or III of the following cancers: breast, colon, lung, or prostate cancer. Cases are presented based on the study’s framework of patient, professional, and system-related barriers to optimal pain relief.

Results

Across all three case presentations, barriers such as fear of side effects from pain medications, fear of addiction, lack of professional knowledge of the basic principles of pain management, and lack of timely access to pain medications due to reimbursement issues are prevalent in cancer survivorship.

Conclusions

Chronic pain syndromes related to cancer treatments are common in cancer survivors. Patient, professional, and system-related barriers that are seen during active treatment continue to hinder optimal pain relief during survivorship.

Implications for cancer survivors

Healthcare providers must acknowledge the impact of chronic, persistent pain on the quality of cancer survivorship. Clinical as well as scientific efforts to increase knowledge in chronic pain management will improve the symptom management of cancer survivors.

Keywords

Survivorship Chronic Pain Management Barriers 

References

  1. 1.
    Committee on Cancer Survivorship: Improving Care and Quality of Life. National Cancer Policy Board. From cancer patient to cancer survivor—lost in transition. Washington, D.C: The National Academies Press; 2006. (http://www.nap.edu).Google Scholar
  2. 2.
    Cleeland CS. The impact of pain on the patient with cancer. Cancer 1984;54(11 Suppl):2635–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Miaskowski C, Dibble SL. The problem of pain in outpatients with breast cancer. Oncol Nurs Forum 1995;22(5):791–7.PubMedGoogle Scholar
  4. 4.
    Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg 2004;99:510–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic pain in the cancer survivor: a new frontier. Pain Med 2007;8:189–98.PubMedCrossRefGoogle Scholar
  6. 6.
    National Institutes of Health State-of-the-Science Statement. Symptom Management in Cancer: Pain, Depression and Fatigue. 2002. http://consensus.nih.gov/2002/2002CancerPainDepressionFatiguesos022main.htm.
  7. 7.
    Deimling GT, Bowman KF, Wagner LJ. The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors. Cancer Nurs 2007;30(6):421–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Schultz PN, Beck ML, Stava C, Vassilopoulou-Sellin R. Health profiles in 5836 long-term cancer survivors. Int J Cancer 2003;104(4):488–95.PubMedCrossRefGoogle Scholar
  9. 9.
    Schroevers M, Ranchor AV, Sanderman R. Adjustment to cancer in the 8 years following diagnosis: a longitudinal study comparing cancer survivors with healthy individuals. Soc Sci Med 2006;63(3):598–610.PubMedCrossRefGoogle Scholar
  10. 10.
    Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain 2005;119(1–3):16–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Ganz PA. Late effects of cancer and its treatment. Sem Oncol Nurs 2001;17(4):241–8.CrossRefGoogle Scholar
  12. 12.
    Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995;6:453–9.PubMedGoogle Scholar
  13. 13.
    Chaudhry V, Rowinsky EK, Sartorius SE, Donehower RC, Cornblath DR. Peripheral neuropathy from taxol and cisplatin combination chemotherapy: clinical and electrophysiological studies. Ann Neurol 1994;35(3):304–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Dougherty PM, Cata JP, Cordella JV, Burton A, Weng HR. Taxol-induced sensory disturbance is characterized by preferential impairment of myelinated fiber function in cancer patients. Pain 2004;109(1–2):132–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Visovsky C. Chemotherapy-induced peripheral neuropathy. Cancer Invest 2003;21(3):439–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Dropcho EJ. Neurotoxicity of cancer chemotherapy. Neurol Semin 2004;24(4):419–26.CrossRefGoogle Scholar
  17. 17.
    Evensen JF, Bjordal K, Knutsen BH, Olsen DR, Store G, Tausjo JE. Side effects and quality of life after inadvertent radiation overdosage in brachytherapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002;52(4):944–52.PubMedGoogle Scholar
  18. 18.
    Small W Jr, Kachnic L. Postradiotherapy pelvic fractures: cause for concern or opportunity for future research. J Am Med Assoc 2005;294(20):2635–7.CrossRefGoogle Scholar
  19. 19.
    Harper CM Jr, Thomas JE, Cascino TL, Litchy WJ. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG. Neurology 1989;39(4):502–6.PubMedGoogle Scholar
  20. 20.
    Wallner K, Elliott K, Merrick G, Ghaly M, Maki J. Chronic pelvic pain following prostate brachytherapy: a case report. Brachytherapy 2004;3(3):153–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Kleinberg L, Wallner K, Roy J, Zelefsky M, Arterbery VE, Fuks Z, et al. Treatment-related symptoms during the first year following transperineal 125I prostate implantation. Int J Radiat Oncol Biol Phys 1994;28(4):985–90.PubMedGoogle Scholar
  22. 22.
    Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003;104(1–2):1–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Tasmuth T, von Smitten K, Kalso E. Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 1996;74(12):2024–31.PubMedGoogle Scholar
  24. 24.
    Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs 1996;19(1):37–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000;93(4):1123–33.PubMedCrossRefGoogle Scholar
  26. 26.
    Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain 1996;12(1):50–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Pluijms WA, Steegers MA, Verhagen AF, Scheffer GJ, Wilder-Smith OH. Chronic post-thoracotomy pain: a retrospective study. Acta Anaesthesiol Scand 2006;50(7):804–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Dajczman E, Gordon A, Kreisman H, Wolkove N. Long-term postthoracotomy pain. Chest 1991;99(2):270–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Kalso E, Perttunen K, Kaasinen S. Pain after thoracic surgery. Acta Anaesthesiol Scand 1992;36(1):96–100.PubMedGoogle Scholar
  30. 30.
    Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand 1999;43(5):563–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Landreneau RJ, Mack MJ, Hazelrigg SR, Naunheim K, Dowling RD, Ritter P, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg 1994;107(4):1079–85. discussion 1085–76.PubMedGoogle Scholar
  32. 32.
    Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 2005;104(9):1998–2005.PubMedCrossRefGoogle Scholar
  33. 33.
    Extermann M, Chen H, Cantor AB, Corcoran MB, Meyer J, Grendys E, et al. Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Eur J Cancer 2002;38(11):1466–73.PubMedCrossRefGoogle Scholar
  34. 34.
    Given CW, Given B, Azzouz F, Kozachik S, Stommel M. Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients. J Pain Symptom Manage 2001;21(6):456–66.PubMedCrossRefGoogle Scholar
  35. 35.
    Kurtz ME, Kurtz JC, Stommel M, Given CW, Given BA. Symptomatology and loss of physical functioning among geriatric patients with lung cancer. J Pain Symptom Manage 2000;19(4):249–56.PubMedCrossRefGoogle Scholar
  36. 36.
    Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Predictors of depressive symptomatology of geriatric patients with colorectal cancer: a longitudinal view. Support Care Cancer 2002;10(6):494–501.PubMedCrossRefGoogle Scholar
  37. 37.
    Stommel M, Kurtz ME, Kurtz JC, Given CW, Given BA. A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate. Health Psychol 2004;23(6):564–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Physical functioning and depression among older persons with cancer. Cancer Pract 2001;9(1):11–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Agency for Health Care Policy and Research. Clinical practice guideline: cancer pain management. Rockville: US Department of Health and Human Services; 1994.Google Scholar
  40. 40.
    Ward SE, Goldberg N, Miller-McCauley V, Mueller C, Nolan A, Pawlik-Plank D, et al. Patient-related barriers to management of cancer pain. Pain 1993;52(3):319–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Paice JA, Toy C, Shott S. Barriers to cancer pain relief: fear of tolerance and addiction. J Pain Symptom Manage 1998;16(1):1–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Ward SE, Carlson-Dakes K, Hughes SH, Kwekkeboom KL, Donovan HS. The impact on quality of life of patient-related barriers to pain management. Res Nurs Health 1998;21(5):405–13.PubMedCrossRefGoogle Scholar
  43. 43.
    Pargeon KL, Hailey BJ. Barriers to effective cancer pain management: a review of the literature. J Pain Symptom Manage 1999;18(5):358–68.PubMedCrossRefGoogle Scholar
  44. 44.
    Ward S, Donovan HS, Owen B, Grosen E, Serlin R. An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Res Nurs Health 2000;23(5):393–405.PubMedCrossRefGoogle Scholar
  45. 45.
    Ward S, Hughes S, Donovan H, Serlin RC. Patient education in pain control. Support Care Cancer 2001;9(3):148–55.PubMedCrossRefGoogle Scholar
  46. 46.
    Potter VT, Wiseman CE, Dunn SM, Boyle FM. Patient barriers to optimal cancer pain control. Psychooncology 2003;12(2):153–60.PubMedCrossRefGoogle Scholar
  47. 47.
    Elliott TE, Murray DM, Elliott BA, Braun B, Oken MM, Johnson KM, et al. Physician knowledge and attitudes about cancer pain management: a survey from the Minnesota cancer pain project. J Pain Symptom Manage 1995;10(7):494–504.PubMedCrossRefGoogle Scholar
  48. 48.
    Wallace KG, Reed BA, Pasero C, Olsson GL. Staff nurses’ perceptions of barriers to effective pain management. J Pain Symptom Manage 1995;10(3):204–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Greenwald BD, Narcessian EJ. Opioids for managing patients with chronic pain: community pharmacists’ perspectives and concerns. J Pain Symptom Manage 1999;17(5):369–75.PubMedCrossRefGoogle Scholar
  50. 50.
    Zaza C, Sellick SM, Willan A, Reyno L, Browman GP. Health care professionals’ familiarity with non-pharmacological strategies for managing cancer pain. Psychooncology 1999;8(2):99–111.PubMedCrossRefGoogle Scholar
  51. 51.
    Ferrell B, Virani R, Grant M, Vallerand A, McCaffery M. Analysis of pain content in nursing textbooks. J Pain Symptom Manage 2000;19(3):216–28.PubMedCrossRefGoogle Scholar
  52. 52.
    McCaffery M, Ferrell BR, Pasero C. Nurses’ personal opinions about patients’ pain and their effect on recorded assessments and titration of opioid doses. Pain Manag Nurs 2000;1(3):79–87.PubMedCrossRefGoogle Scholar
  53. 53.
    Glajchen M, Bookbinder M. Knowledge and perceived competence of home care nurses in pain management: a national survey. J Pain Symptom Manage 2001;21(4):307–16.PubMedCrossRefGoogle Scholar
  54. 54.
    Randall-David E, Wright J, Porterfield DS, Lesser G. Barriers to cancer pain management: home-health and hospice nurses and patients. Support Care Cancer 2003;11(10):660–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Gee RE, Fins JJ. Barriers to pain and symptom management, opioids, health policy, and drug benefits. J Pain Symptom Manage 2003;25(2):101–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Joranson DE. Are health-care reimbursement policies a barrier to acute and cancer pain management. J Pain Symptom Manage 1994;9(4):244–53.PubMedCrossRefGoogle Scholar
  57. 57.
    Gilson AM, Joranson DE. Controlled substances and pain management: changes in knowledge and attitudes of state medical regulators. J Pain Symptom Manage 2001;21(3):227–37.PubMedCrossRefGoogle Scholar
  58. 58.
    Polomano RC, Farrar JT. Pain and neuropathy in cancer survivors. Surgery, radiation, and chemotherapy can cause pain; research could improve its detection and treatment. Am J Nurs 2006;106(3 Suppl):39–47.PubMedGoogle Scholar
  59. 59.
    Lyne ME, Coyne PJ, Watson AC. Pain management issues for cancer survivors. Cancer Pract 2002;10(Suppl 1):S27–32.PubMedCrossRefGoogle Scholar
  60. 60.
    Sun VC, Borneman T, Ferrell B, Piper B, Koczywas M, Choi K. Overcoming barriers to cancer pain management: an institutional change model. J Pain Symptom Manage 2007;34(4):359–69.PubMedCrossRefGoogle Scholar
  61. 61.
    The National Comprehensive Cancer Network. Practice guidelines in oncology: adult cancer pain version 1.2007. http://nccn.org.
  62. 62.
    Schumacher KL, West C, Dodd M, Paul SM, Tripathy D, Koo P, et al. Pain management autobiographies and reluctance to use opioids for cancer pain management. Cancer Nurs 2002;25(2):125–33.PubMedCrossRefGoogle Scholar
  63. 63.
    Levin ML, Berry JI, Leiter J. Management of pain in terminally ill patients: physician reports of knowledge, attitudes, and behavior. J Pain Symptom Manage 1998;15(1):27–40.PubMedCrossRefGoogle Scholar
  64. 64.
    Morrsion RS, Wallenstein S, Natale DK, Senzel RS, Huang L-L. “We don’t carry that”—Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med 2000;342:1023–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Virginia Sun
    • 1
  • Tami Borneman
    • 1
  • Barbara Piper
    • 2
  • Marianna Koczywas
    • 3
  • Betty Ferrell
    • 1
  1. 1.Department of Nursing Research and Education, Division of Population SciencesCity of HopeDuarteUSA
  2. 2.Department of Nursing Research, Virginia G. Piper Cancer CenterUniversity of ArizonaScottsdaleUSA
  3. 3.Department of Medical Oncology and Therapeutics ResearchCity of HopeDuarteUSA

Personalised recommendations