A holistic approach to the treatment of cancer pain that helps patients cope with their psychological, social and spiritual needs, as well as managing pain, might enhance treatment outcomes, ease suffering and improve quality of life, according to the third paper in The Lancet Series on pain.

“Efforts to relieve pain are welcome, but might not adequately improve quality of life or reduce suffering if they unfold separately from the so-called whole-person concerns associated with serious life-threatening illness…a broad therapeutic approach know as palliative care…is needed to address these complex needs,” explains Russell Portenoy from Beth Israel Medical Center in New York.

Research suggests that poorly relieved cancer pain is common and as many as 43 percent of cancer patients receive analgesics in a manner that is inconsistent with internationally accepted guidelines. Traditionally, the long-term treatment of cancer pain has focused on treating the physical symptoms, but most patients have several ailments, many symptoms and other concerns. Moreover, communication problems between patients, family and health professionals can lead to uncertainty about the goals of care, a lack of advanced care planning, increase the burden on caregivers and heighten distress.

Given the complexity of this clinical situation, there is growing recognition of the benefits of integrating palliative care into the management of cancer pain. A recent controlled study found that lung cancer patients offered support by a specialist palliative care team from the time of diagnosis experienced less depression, reported an improved quality of life, and lived 3 months longer than patients given usual care.

Although historically offered at the end of life, this broader strategy introduces palliative care interventions from the time of diagnosis as a part of disease management, and recognizes the value of specialist palliative care when the complexity of the situation calls for it.

Portenoy remarks, “The [palliative care] model applies throughout the course of the illness and includes interventions that are intended to maintain quality of life, mitigate suffering and improve coping and adaption by reducing the burden of illness and supporting communication, autonomy, and choice.”

The paper describes state-of-the-art approaches to the management of pain in patients with active disease. Opioid pharmacotherapy is the mainstay approach, but the paper also discusses the important role of non-drug treatments. Therapies that range from injections and neural blockade, to cognitive strategies such as relaxation training, guided imagery and hypnosis all might be useful.

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