Implementing Therapy With Opioids in Cancer Patients

Julie Sparlin, MD
Fellow, Pain Medicine

Oscar de Leon-Casasola, MD
Professor of Anesthesiology and Medicine
Vice-Chair for Clinical Affairs

Department of Anesthesiology
University at Buffalo School of Medicine and Biomedical Sciences
Chief, Pain Medicine and Professor of Oncology
Roswell Park Cancer Institute
Buffalo, NY

Introduction - TOP

Pain is one of the most common, and feared, symptoms associated with cancer (National Comprehensive Cancer Network, 2007). Often, the chief complaint of patients with advanced cancer is pain. As patients live longer, there is an increased need for effective pain control to improve quality of life.1  Although the lack of diagnostic tests makes it difficult to define the exact prevalence, pain occurs in approximately 25% of patients with newly diagnosed cancer, 33% of patients undergoing treatment, and 75% of patients with advanced disease.

Indeed, an estimated 90% of patients experience at least moderate pain at some point in their illness and 42% do not receive adequate palliation.  Undertreated cancer pain is a particular problem in women, minority ethnic groups, and the elderly.1  Unrelieved pain denies patients comfort and greatly affects activities, motivation, interactions with families and friends, and overall quality of life.2

As the area of palliative care continues to increase, efforts to improve pain control will continue to be an essential element of cancer care.3  Yet there are a number of barriers to effective pain relief including inadequate assessment by practitioners, underreporting of pain by patients and families, practitioners’ lack of knowledge regarding current treatment, lack of accountability for effectively treating pain, fear of overregulation by government officials, and inadequate reimbursement for pain treatment or excessive administrative demands on healthcare providers.1  In fact, in the nearly 70 years since regulatory controls were placed on opioid use, it has been difficult to rebuild confidence in the use of opioids as an effective, safe, and humane treatment for cancer pain.

With the therapies currently available to clinicians, up to 99% of cancer pain can be controlled with the use of aggressive multimodal pharmacologic therapy and invasive techniques.1  In 2010, there is no reason for most cancer patients to be in pain.

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