Editorial: Striving for Safe, Effective, Affordable Care for Cancer Survivors With Chronic Pain: Another Kind of Moonshot

Editorial (partial view)
Striving for Safe, Effective, Affordable Care for Cancer Survivors With Chronic Pain:  Another Kind of Moonshot

 Pain is a complex clinical problem and the oldest physical affliction of mankind.¹ Assessing and managing acute and chronic pain and appropriately prescribing opioids is a key component of providing optimal care for patients with cancer. In outpatient oncology, approximately two-thirds of patients report pain and/or use analgesics for pain.² Among long-term survivors of cancer, an estimated 5% to 10% have chronic, severe pain that interferes with functioning and employment.³ The Centers for Disease Control and Prevention (CDC) recently conducted a systematic review on the effectiveness and risks of opioids for chronic pain, culminating with a rigorously developed guideline with 12 recommendations.⁴ A diverse array of medical specialties were asked to comment on this guideline, and the process exemplified standards for developing trustworthy clinical guidelines.⁵ The guideline produced 3 items addressing when to initiate or continue opioids for chronic pain; 4 items about opioid selection, dosage, follow-up, and duration; and 5 items related to assessing risk and addressing the harms of opioid use (Box). Opioid use in cancer care and end-of-life care were excluded from the guidelines. Nevertheless, these recommendations are relevant to the oncology and palliative care community because of the growing population of cancer survivors, many of whom are living with serious chronic pain.