Managing Relentless Pain in Cancer Survivors

Laura A. Stokowski, RN, MS

Disclosures

February 16, 2011

In This Article

An Interview With Judith Paice, PhD, RN, FAAN

About the Interviewee

Judith Paice, PhD, RN, FAAN, is Director of the Cancer Pain Program in the Division of Hematology-Oncology and Research Professor of Medicine at Northwestern University's Feinberg School of Medicine. Dr. Paice served as President of the American Pain Society from 2006 to 2008 and is currently Secretary of the International Association for the Study of Pain. Much of Dr. Paice's clinical work has been in the relief of pain associated with cancer and HIV disease. She has traveled within the People's Republic of China, Indonesia, Japan, Kenya, Korea, Taiwan, Tanzania, and Tajikistan to educate healthcare professionals about cancer pain relief and palliative care. Dr. Paice serves as Associate Editor of the Journal of Pain and serves on the editorial board of the Clinical Journal of Pain and the Journal of Pain and Symptom Management and is the author of more than 150 scientific manuscripts. She was one of the original consultants in the End-of-Life Nursing Education Consortium (ELNEC) and has continued serving as a faculty member in this program.

Surviving Cancer: The Painful Reality

People with cancer are living longer than ever before.

Today, 66% of people diagnosed with cancer are expected to live at least 5 years, and 10-year survival is approaching 60%.[1] The number of cancer survivors in the United States has grown steadily over the past few decades and now stands at 11.7 million individuals.[2] Improved cancer treatments have even extended the survival of patients with advanced cancer, many of whom are living longer than was previously thought possible.[3]

Increased Survival Requires Management of Survivor Symptoms

One of the consequences of living longer is the symptom burden of cancer survivorship, which is having a substantial impact on quality of life for many survivors.[4] Persistent and late effects of cancer treatment include physical limitations, cognitive sequelae, depression, anxiety, sleep problems, fatigue, sexual dysfunction, and, in some patients, a great deal of pain.[5]

"Our cancer treatments are unfortunately leaving people with significant pain syndromes," observed Dr. Paice, adding "although they are not new, these pain syndromes are on our radar screens more now than they were a couple of years ago."

Dr. Judith Paice

As cancer survivors reduce the frequency of visits with their oncologists in the months and years following completion of their cancer treatments, their ongoing needs are often taken over by their primary care providers. Treatment-related pain is a chronic, long-term issue for many cancer survivors, and their primary care providers must be aware of the possible sources of treatment-related pain, know how to thoroughly assess patients for such pain, and manage these unique pain syndromes according to the best available evidence or make appropriate referrals to pain management specialists.

Chronic Pain Associated With Cancer Treatment

Of all types of pain suffered by patients with cancer, malignancy-related pain and end-of-life pain have received the most attention, and treatment-related pain the least.[6] As survival lengthens, persistent pain is no longer acute but chronic, and chronic pain must, in many cases, be managed differently.[7] Because cancer treatment-related pain is a relatively new phenomenon, or at least a relatively newly recognized one, no accurate data yet exist on the extent of the problem. Green, Hart-Johnson, and Loeffler recently documented that 43% of a diverse population of cancer survivors had experienced pain since their diagnoses, and 20% suffered chronic cancer-related pain.[8] These figures are likely to underrepresent the problem.

Dr. Paice sees many of these patients in her practice, and she is not surprised that no accurate numbers exist to give us an adequate grasp of the prevalence of chronic treatment-related pain. "The early clinical trials were looking at how effective the cancer drugs and other treatments were; they weren't systematically measuring all of the adverse effects. And patients were hesitant to admit that they were having a side effect such as pain because they were afraid they would be dropped from the trial," she explained.

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