You are currently viewing Cancer & Cancer Pain

Cancer & Cancer Pain

What is Cancer?

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Cancer Pain Sufferers are Growing

According to the National Cancer institute, in 2018, an estimated 1,735,350 new cases of cancer were diagnosed in the United States and 609,640 people were projected to die from the disease. In 2016, there were an estimated 15.5 million cancer survivors in the United States. The number of cancer survivors is expected to increase to 20.3 million by 2026. Approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2013–2015 data).

Pain is one of the most feared complications of cancer. The International Association for the Study of Pain (IASP) estimates that the prevalence of pain at the time of cancer diagnosis and early in the course of disease is approximately 50%, increasing to 75% at advanced stages. The prevalence of pain in cancer survivors may be as high as 33%. Although reports of pain according to type of cancer vary widely, the IASP presents estimates of pain as highest in the following types of cancer: Head and neck (67–91%), Prostate (56–94%), Uterine (30–90%), Genitourinary (58–90%), Breast (40–89%) and Pancreatic (72–85%).

Pain caused by cancer is dynamic and can change rapidly. Pain may be from the cancer itself (tumors, obstruction or compression of other tissues by tumors), treatments for the cancer (radiation, surgery, chemotherapy) or may be from an indirect effect of cancer.

Treatments

Treatment for this pain is varied. Oftentimes, treatment of the cancer itself leads to decreased pain. In cases where the pain is severe, medications are often used to control pain. These medications may include both opioids (“narcotic”) pain medications and non-opioid pain medications. There is increasing interest in the use of marijuana and its derivatives (CBD, THC) in treating both pain and other unpleasant symptoms of cancer and cancer treatment, such as nausea. In certain cases, pain may be treated with nerve blocks or destruction of certain nerves.

Cancer & Cancer Pain

Treatment of pain related to cancer can be difficult, sometimes requiring much higher doses of medications typically used for non-cancer pain. Sometimes, side effects from high doses of pain medications can limit their usefulness or cause other issues such as itching, nausea, vomiting, constipation and bowel obstruction. In some cases, an intrathecal pump, i.e. “pain pump,” can be used to deliver medication with lower incidence of side effects. These pumps require specialized organization and management teams that are only available in some areas. Because of the complexity of cancer pain management, it is often done by physician and non-physician specialists such as oncologists, palliative care and pain management providers.

Quality of Life Vs Quantity of Life

When cancer is advanced with a low likelihood of cure, focus may be geared towards quality of life as opposed to “quantity” of life. Palliative care physicians, nurse practitioners and physician assistants specialize in this patient-centered approach. Palliative care does not mean that a patient is “giving up” or “waiting to die,” only that the focus is on the patient’s quality of life and comfort. In advanced and end-stage cancer, oftentimes hospice care is initiated, where the sole focus is the patient’s comfort, not necessarily further treatment of the cancer. The focus of treatment of cancer and cancer-associated pain should always be driven by the patient’s goals, but when a poor-prognosis is anticipated, multiple studies have shown that patient and family satisfaction is highest with early referral to palliative care.

It takes a village

Cancer is complicated, and there is no one-size-fits-all approach to management. The most important aspect of managing cancer and pain caused by cancer is having a full team of healthcare providers that can address all aspects of the disease, from a primary care provider to oncologists to social workers, everyone specializes in their own area to best serve the patient. The good news is that even in advanced, end-stage cancer, most cases pain can be adequately managed.

Cancer Pain

What is Cancer?

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Cancer Pain Sufferers are Growing

According to the National Cancer institute, in 2018, an estimated 1,735,350 new cases of cancer were diagnosed in the United States and 609,640 people were projected to die from the disease. In 2016, there were an estimated 15.5 million cancer survivors in the United States. The number of cancer survivors is expected to increase to 20.3 million by 2026. Approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2013–2015 data).

Pain is one of the most feared complications of cancer. The International Association for the Study of Pain (IASP) estimates that the prevalence of pain at the time of cancer diagnosis and early in the course of disease is approximately 50%, increasing to 75% at advanced stages. The prevalence of pain in cancer survivors may be as high as 33%. Although reports of pain according to type of cancer vary widely, the IASP presents estimates of pain as highest in the following types of cancer: Head and neck (67–91%), Prostate (56–94%), Uterine (30–90%), Genitourinary (58–90%), Breast (40–89%) and Pancreatic (72–85%).

Pain caused by cancer is dynamic and can change rapidly. Pain may be from the cancer itself (tumors, obstruction or compression of other tissues by tumors), treatments for the cancer (radiation, surgery, chemotherapy) or may be from an indirect effect of cancer.

 

Cancer & Cancer Pain

Treatments

Treatment for cancer pain is varied. Oftentimes, treatment of the cancer itself leads to decreased pain. In cases where cancer pain is severe, medications are often used to control pain. These medications may include both opioids (“narcotic”) pain medications and non-opioid pain medications. There is increasing interest in the use of marijuana and its derivatives (CBD, THC) in treating both pain and other unpleasant symptoms of cancer and cancer treatment, such as nausea. In certain cases, cancer pain may be treated with nerve blocks or destruction of certain nerves.

Treatment of cancer pain can be difficult, sometimes requiring much higher doses of medications typically used for non-cancer pain. Sometimes, side effects from high doses of pain medications can limit their usefulness or cause other issues such as itching, nausea, vomiting, constipation and bowel obstruction. In some cases, an intrathecal pump, i.e. “pain pump,” can be used to deliver medication with lower incidence of side effects. These pumps require specialized organization and management teams that are only available in some areas. Because of the complexity of cancer pain management, it is often done by physician and non-physician specialists such as oncologists, palliative care and pain management providers.

Quality of Life Vs Quantity of Life

When cancer is advanced with a low likelihood of cure, focus may be geared towards quality of life as opposed to “quantity” of life. Palliative care physicians, nurse practitioners and physician assistants specialize in this patient-centered approach. Palliative care does not mean that a patient is “giving up” or “waiting to die,” only that the focus is on the patient’s quality of life and comfort. In advanced and end-stage cancer, oftentimes hospice care is initiated, where the sole focus is the patient’s comfort, not necessarily further treatment of the cancer. The focus of treatment of cancer and cancer-associated pain should always be driven by the patient’s goals, but when a poor-prognosis is anticipated, multiple studies have shown that patient and family satisfaction is highest with early referral to palliative care.

It takes a village

Cancer is complicated, and there is no one-size-fits-all approach to management. The most important aspect of managing cancer and cancer pain is having a full team of healthcare providers that can address all aspects of the disease, from a primary care provider to oncologists to social workers, everyone specializes in their own area to best serve the patient. The good news is that even in advanced, end-stage cancer, most cases of cancer pain can be adequately managed.