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SIP 2017 - Key Statement

Dr. Stefan Wirz – CURA-Hospital, Germany

"Pain specialists must be involved in cancer treatment at an earlier stage. Interprofessional communication between oncologists, palliative specialist and pain specialists must be improved."


Dr. Stefan Wirz
GFO
CURA-Hospital

Due to advances in oncologic therapies, 5-year survival rates increased to nearly 70%. However, chronic pain arises in his population frequently as an undesirable effect after oncologic surgery, chemotherapy or radiotherapy. Tumours are capable to initiate an escalation of pain via tissue processes. Also genetic variables may lead to elevated pain levels in several types of tumours. Significant predictors for chronic pain are nerve damage (‘neuropathic pain’), higher pain levels at the beginning of the disease, and demographic variables. Further on, also psychosocial factors are associated with chronic cancer pain. Whereas the impact of these variables is well known in chronic non-cancer pain, the association of psychodynamic mechanisms with chronic cancer often is neglected.

The rate of chronic cancer pain amounts to 20% of cancer survivors and approximately 40% of cancer patients suffer from pain during the course of their oncologic treatment. Overall, the numbers of cancer patients with an insufficient pain therapy in western countries reaches 50%. Multifarious reasons for this under treatment are: problems related to the health care system, such as deficiencies in education resp. training in pain medicine, problems related health care professionals, problems related to patients, such as concerns about opioids, and communicative barriers of both physicians and patients. Many physicians reveal deficiencies in pain assessment, e.g. problems in diagnosing nerve pain in cancer patients. Otherwise, many patients with chronic cancer pain feel reserved to attend palliative specialists, because in contrast to the palliative population, cancer survivors show no need for palliative medicine. The relevance of an adequate pain control is underlined by the fact that an adequate pain therapy at an early stage of a cancer disease shows a positive effect on both quality of life and survival rates. Therefore, an early integration of pain specialists in the curative cancer treatment is compulsory. However, a differentiation of cancer pain according to different stages should be made, because patients’ needs differ in the ‘palliative’ and ‘non-palliative’ situation.

In summary

  • early integration of pain specialists at an early stage of a cancer resp. its oncologic treatment
  • educational programmes on pain medicine in academic institutions and medical capacities
  • investigation on epidemiology, diagnosis, and treatment of chronic cancer pain are warranted

Stefan Wirz, PhD, MD, is Chair of the Special Interest Group Cancer Pain of the IASP (International Association for the Study of Pain), speaker of the Working Group Cancer Pain of the German Pain Society and has been involved in the German Guideline Program in Oncology. He completed his PhD thesis on pain and symptom control in cancer pain, published many publications on this topic, and is speaker at national and international congress.