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Cancer Pain: Assessment, Management, and Patient Empowerment

This article was written in collaboration with Christine T. and ChatGPT, our little helper developed by OpenAI.

Cancer pain occurs in the advanced stages of the disease when the tumor spreads to adjacent tissues and organs. Despite the modern medical progress, pain associated with cancer is experienced by 59% of patients in active treatment, 33% of survivors after treatment, and 64% of patients with a metastatic, progressive or terminal illness. The issue of adequate anesthesia remains important in oncology because cancer pain not only signifies the progression of the disease but also lowers the life quality of the patients and their relatives. To relieve cancer pain in clinical oncology, doctors use the safe and effective injection of opioids, which reduces pain intensity and improves the cancer patient’s general condition. However, numerous studies and researches show that cancer pain assessment and management have many problems. An educational program to increase understanding of the causes and types of cancer pain, enhanced communication between nurses and patients, and patients’ empowerment will help to overcome gaps in cancer pain management.

Cancer Pain in Adults

Cancer pain causes a painful feeling that passes through the body, mind, and spirit and affects a person’s social interaction, which lowers the quality of life of the patient and his/her family. According to Arnstein, 8 million people suffer from cancer pain worldwide, and 14 million new cases of the disease are diagnosed yearly. The researcher summarizes a recent study on the biological mechanisms, psychological impact and evidence-based approaches to pain management in adults. The author aims to inform nurses about the best practices they can use to prevent suffering caused by cancer pain. Bowlt et al. state that uncontrolled pain is one of adult cancer patients’ most awesome and debilitating cancer symptoms. Pain associated with cancer is common during the entire illness and even after treatment. About 20% of chronic and acute pain cases in cancer patients are associated with the adverse effects of chemotherapy, surgery, and radiation. People with cancer should not live or die with cancer pain due to the harmful effects they have had for a long time, affecting their quality of life.

Pain Assessment, Management and Treatment in Oncology Patients

Cancer pain assessment and management often determine inaccurate pain that affects health and functioning or does not identify known risks associated with treatment. Despite the development of the theoretical base of evidence-based medicine aimed at evaluating and supporting interventions in the treatment of cancer pain, patients still have many problems in clinical practice. Shute argued that pharmacological treatment of cancer pain is often a necessary manipulation. However, it requires knowledge and the influence of multiple factors to prevent potentially life-threatening medication effects. A combination of targeted therapies is available to combat pain; however, given the variability of responses, even to the same type of treatment, several therapeutic studies may be required to establish the safest and the most effective treatment plan for oncology patients. Today, a multimodal approach that includes the biopsychosocial and individual aspects of cancer pain is the best practical method that nurses and doctors should use.

An effective evaluation of pain in cancer patients in the clinical conditions of major pain syndromes and mechanisms allows healthcare providers to make the most successful treatment plan to control cancer pain. The researchers Bruera and Paice say that most physicians use opioid analgesia to treat the disease. Indeed, opioid analgesics are of great value due to their central role in controlling cancer pain; however, they are often misused. Some doctors use them with mild pain; others prescribe adequate doses without observing the patient’s response. In addition, doctors do not accurately determine the necessary dose of the drug for the patient or do not prescribe adjuvant drugs. There is a misconception about the risk of addiction or opioid-induced respiratory depression. Pain is a powerful respiratory stimulator that partly counteracts the depressive effects of precipitation. Addiction rarely develops, even in the case of a long period of use of drugs. For a patient with advanced cancer who needs opioids, addiction and physical dependence are not considered a compelling reason for canceling or denying their appointment.

Moreover, adequate management of cancer patient’s psychosocial, spiritual and physical problems involves relieving pain. It is achieved through an individualized treatment plan that includes pharmacological or procedural therapies in clinical oncology. The assessment of exact symptoms, management and treatment of cancer pain in clinical oncology can help relieve pain and improve the general condition of cancer patients and achieve the best quality of life at all stages of the disease.

Patient Empowerment

Patients’ efforts in managing cancer pain are an important tool that becomes necessary not only for patients but also for doctors and nurses to overcome or reduce pain. The research by Bowlt et al. indicates that more than half of cancer patients suffer acute pain. A special place in pain management in oncology takes the empowerment of patients to fight and control pain themselves. Unfortunately, there is no sustainable model of pain management in oncology patients, but in clinical practice, several strategies are used to reduce cancer pain. Expanding patients’ empowerment or associated pain control methods provides new opportunities for pain management in oncology. Patient empowerment includes self-realization, active participation of patients in treatment together with nurses and physicians, capacity expansion and life management, active problem solving and joint decision-making. Boveldt et al. suggests a concerted model that enables patients, physicians, and nurses to control and manage cancer pain. Such a model focuses on the treatment of pain provided by a healthcare professional, the active involvement of the patient, and their joint engagement to achieve positive results.

Barriers to Cancer Pain Management

Cancer pain is inadequately managed due to the misunderstanding or complete neglect of the problem by oncologists or nurses. Many physicians lack knowledge about cancer and consider the oncology patients’ condition hopeless, preventing them from accepting that they can relieve and control pain if it is adequately managed and evaluated. Thus, Kwon noted that healthcare workers lack knowledge of cancer pain, for example, how to manage various pains, combine different anesthetics and manage side effects. Similarly, Fishman et al. emphasize that insufficient training of health workers is the major barrier to the safe and effective management of cancer pain. The lack of knowledge, negative clinic environment, insufficient number of specialists, and poor patient behavior are significant barriers for healthcare workers in controlling cancer pain. Therefore, creating core competencies in healthcare assessment and management of cancer patients will help avoid challenges and gaps in oncology. Nurses can assess cancer pain and determine how to act in different situations with the patient. However, in practice, nurses do not use appropriate pain scales or carry out thorough and complete pain assessments even if they know them. Many doctors specializing in surgery and medical or radiation oncology gain insufficient knowledge of managing cancer pain and thus are guided by experience, which is acquired more empirically.

Pain education is important for achieving good results in nursing, thanks to understanding pain. Fishman et al. studied the specific pain literature and attracted an interprofessional Competency Advisory Committee to develop core competencies for cancer pain management. The results were the competencies divided into four groups: multi-dimensional pain, pain assessment and measurement, pain management, and pain control. These groups relate to the basic concepts and complications of pain; observation and evaluation of pain; common approaches to treatment methods; and the use of the competencies throughout life in the context of different parameters and models, groups of people and medical professionals. The achievements in pain-related programs occurred in parallel with learning innovations and advanced training and learning skills. Such competencies and innovations reduce the emphasis on theoretical knowledge and enhance the ability of nurses to act effectively in complex, diverse pain management situations. Overcoming these barriers will help the management and control of cancer pain.

Role of Nurses

Cancer nurses must have communication skills to improve patient care in pain management in oncology. Canivet et al. argued that effective communication is necessary for optimal cancer pain management. Specific training modules for communication between nurses and patients help improve pain outcomes and develop new guidelines for managing cancer pain. General medical practice shows that advanced communication skills have improved the methods needed to manage cancer pain in nurses. The purpose of contact between the nurse and the patient is to improve the medical care one participant provides in the communication process to the other. Such relationships depend on the conditions in which the medical activity is carried out. Hence, contacts in the patient’s nurse-patient interaction system are another important aspect of cancer pain management.

Conclusion

Most people with cancer suffer from long-term pain that persists even after treatment. Adequate and professional pain management reduces disease progression and improves patients’ well-being. In oncology practice, cancer pain management involves using various methods and strategies, both pharmacological and psychological. Opioid treatment is a safe method of alleviating pain in oncology patients. Furthermore, the patient’s efforts and effective communication with the nurses help to relieve cancer pain. However, despite the positive research results of cancer pain management in oncology patients, medicine has gaps and barriers that prevent effective cancer pain reduction. Cancer education and interaction between patients and nurses are ways to overcome the problems associated with treating cancer pain.

📎 References:

1. Arnstein, P. (2018). Adult cancer pain: An evidence-based update. Journal of Radiology Nursing, 37(1), 15-20. https://doi.org/10.1016/j.jradnu.2017.10.009
2. Boveldt, N. T., Vernooij-Dassen, M., Leppink, I., Samwel, H., Vissers, K., & Engels, Y. (2014). Patient empowerment in cancer pain management: An integrative literature review. Psycho-Oncology, 23(11), 1203-1211. https://doi.org/10.1002/pon.3573
3. Bruera, E., & Paice, J. A. (2015). Cancer pain management: Safe and effective use of opioids. American Society of Clinical Oncology Educational Book, 35. https://doi.org/10.14694/edbook_am.2015.35.e593
4. Canivet, D., Delvaux, N., Gibon, A., Brancart, C., Slachmuylder, J., & Razavi, D. (2014). Improving communication in cancer pain management nursing: A randomized controlled study assessing the efficacy of a communication skills training program. Supportive Care in Cancer, 22(12), 3311-3320. https://doi.org/10.1007/s00520-014-2357-2
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6. Fishman, S.M., Young, H. M., Arwood, E. L., Chou, R., Herr, K., Murinson, B. B., & Strassels, S. A. (2013). Core competencies for pain management: Results of an interprofessional consensus summit. Pain Medicine, 14(7), 971–981. https://doi.org/10.1111/pme.12107
7. Kwon, J. H. (2014). Overcoming barriers in cancer pain management. Journal of Clinical Nursing, 32(16), 1727-1733. https://doi.org/10.1200/jco.2013.52.4827
8. Shute, C. (2013). The challenges of cancer pain assessment and management. Ulster Medical Journal, 82(1), 40–42.