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Strategies for interventional therapies in cancer-related pain—a crossroad in cancer pain management

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Abstract

Purpose

Interventional therapies are important to consider when facing cancer pain refractory to conventional therapies. The objective of the current review is to introduce these effective strategies into dynamic interdisciplinary pain management, leading to an exhaustive approach to supportive oncology.

Methods

Critical reflection based on literature analysis and clinical practice.

Results

Interventional therapies act on the nervous system via neuromodulation or surgical approaches, or on primitive or metastatic lesions via interventional radiotherapy, percutaneous ablation, or surgery. Interventional therapies such as neuromodulations are constantly evolving with new technical works still in development. Nowadays, their usage is better defined, depending on clinical situations, and their impact on quality of life is proven. Nevertheless their availability and acceptability still need to be improved. To start with, a patient’s interdisciplinary evaluation should cover a wide range of items such as patient’s performance and psychological status, ethical considerations, and physiochemical and pharmacological properties of the cerebrospinal fluid for intrathecal neuromodulation. This will help to define the most appropriate strategy. In addition to determining the pros and cons of highly specialized interventional therapies, their relevance should be debated within interdisciplinary teams in order to select the best strategy for the right patient, at the right time.

Conclusions

Ultimately, the use of the interventional therapies can be limited by the requirement of specific trained healthcare teams and technical support, or the lack of health policies. However, these interventional strategies need to be proposed as soon as possible to each patient requiring them, as they can greatly improve quality of life.

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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. Pain Management Unit, Mutualist Clinic of la Porte-de-Lorient, Lorient, France

    Gilles Allano

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

    Brigitte George

  3. Anesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France

    Christian Minello

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

    Alexis Burnod

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

    Caroline Maindet

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

    Antoine Lemaire

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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. 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; participation to a clinical study without honoraria from Bouchara. 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. 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. 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. 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, and Prostrakan, outside the submitted work.

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Allano, G., George, B., Minello, C. et al. Strategies for interventional therapies in cancer-related pain—a crossroad in cancer pain management. Support Care Cancer 27, 3133–3145 (2019). https://doi.org/10.1007/s00520-019-04827-9

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