Management of Chronic Pain in Survivors of Adult Cancers: ASCO

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 INTRODUCTION

As a result of extraordinary advancements in diagnosis and treatment, approximately 14 million individuals with a history of cancer (excluding nonmelanomatous skin cancers) are living in the United States.¹ Two thirds of these individuals are surviving ≥ 5 years after diagnosis.² Unfortunately, these impressive outcomes in survival often come with physical, psychosocial, and financial burdens as a result of the tumor, exposure to cancer treatment, or other medical comorbidities. Chronic pain can be a serious, negative consequence of surviving cancer. Although estimates vary, the prevalence of pain in cancer survivors has been reported to be as high as 40%.^3-5 Predictors include the type and invasiveness of the tumor, the treatment regimen used, the time since cancer treatment, and the efficacy of initial pain therapy. Significant pain is associated with impaired quality of life in this population.⁶

Many guidelines and recommendations have been advanced to support the management of cancer pain, yet the focus of these documents has been primarily on relieving acute pain or pain associated with advanced disease.^7,8 Few evidence-based cancer pain guidelines address the more nuanced care required when pain persists for months or years. This situation is in part caused by the relative absence of studies exploring the experiences of chronic pain in cancer survivors, or the long-term safety and effectiveness of analgesic interventions.....