1889P - Addressing unmet needs in the management of persistent severe cancer pain: European expert recommendations

Background

Cancer pain management remains insufficient for about 40% of patients significantly impacting their quality of life (QoL). This study provides comprehensive recommendations to address current unmet needs in managing persistent severe cancer pain.

Methods

Two expert committees of oncologists and pain specialists (n=15) developed a clinical practice survey covering aspects of managing persistent severe cancer pain (diagnosis, assessment, conventional and interventional therapies, follow-up, and referral to pain units). 77 European medical oncologists with ≥5 years of post-residency experience completed the survey. Identified controversies included lack of education, such as low awareness of therapeutic pain options and poor adherence to current recommendations on cancer pain management. 15 recommendations were then proposed and agreed during a joint Delphi-like meeting of the committees (9-point rating scale [9=full agreement]; consensus ≥75% of response in the same tertile).

Results

After two rounds, consensus was obtained in 13 recommendations (81.25%) on the following areas: 1) Education for oncologists: Organize sessions on cancer pain by pain units, including guidelines/protocols, cases/real world experience, and treatment outcomes (100%]), and guidance on appropriate patients for interventional techniques (80%); 2) Inter-specialty collaboration: Create specific committees for cancer pain treatment (87%); Drive telematic consultations with pain units (100%); Establish common treatment protocols (100%) and referral criteria (100%); Address early communication on pain management and pain unit’s role as a key driver in patient QoL (87%); Ensure access to a pain specialist in all centers treating cancer (93%); 3) Referral to a pain unit: Refer if pain is an initial symptom (80%) or persistent severe cancer pain patients with poor QoL (100%); Refer regardless of the pain location (100%) or the presence of adverse events due to chemotherapy (100%) or conventional pain treatment (87%).

Conclusions

Defining patient referral criteria and promoting multidisciplinary collaboration between the Oncology and Pain Units are key areas to improve persistent severe cancer pain management.

Clinical trial identification

Editorial acknowledgement

Medical writing services were provided by VML Health Spain (Elena Gómez García).

Legal entity responsible for the study

ESTEVE, Medtronic.

Funding

ESTEVE, Medtronic.

Disclosure

M. di Palma: Financial Interests, Personal, Invited Speaker: Amgen, KyowaKirin, MSD, BMS, Mundipharma, Astellas, Ipsen, Lilly, Merck, Gilead, Roche, Novartis; Financial Interests, Personal, Advisory Board: AstraZeneca, Sandoz, Esteve, AstraZeneca, Janssen, Pfizer, Roche, VIIV Lelthcare, FreseniusKabi, Mundipharma; Financial Interests, Institutional, Other, preceptorship: Sandoz; Financial Interests, Personal, Other, masterclass: Daiichi, Beigene; Financial Interests, Personal, Other, travel expenses: Viatris; Financial Interests, Institutional, Invited Speaker: Resilience; Financial Interests, Personal, Other, Travel expenses: Viatris; Financial Interests, Personal, Steering Committee Member: Fresenius, Bayer; Financial Interests, Institutional, Other, investigator: Sandoz, Pierre Fabre, Novartis, Ipsen, Janssen, AstraZeneca; Non-Financial Interests, Member of Board of Directors: French Speaking Association for Supportive Care in Cancer; Non-Financial Interests, Other, member: Ethical Comittee of the French National League against cancer. C. Hoefing: Financial Interests, Personal, Advisory Board: Medtronic, Sintetica. S. Bagchi: Financial Interests, Personal, Advisory Board: Medtronic; Financial Interests, Personal, Other, Travel and accommodation grant: Esteve; Financial Interests, Personal, Training: Boston Scientific; Financial Interests, Personal, Other, Neuromodulation meeting: NEVRO. T. Macarulla Mercade: Financial Interests, Personal, Advisory Board: Ability Pharmaceutical, SL, AstraZeneca, Basilea Pharma, Batxer, BioLineRX Ltd, Celgene SLU, Eisai, IPSEN Pharma, Incyte; Financial Interests, Personal, Other, Direct research fund: Servier, Merck, Sharp and Dhome, Novocure, QED Therapeutics Inc, Roche, Sanofi-Aventis, Zymeworks; Financial Interests, Personal, Invited Speaker: Lilly, Janssen; Financial Interests, Institutional, Research Grant: Amc Medical Research, Armo Biosciences, Basilea, Biokeralty Research Institute, Merck Sharp & Dohme, Oncomed Pharmaceuticals, QED Therapeutics, VCN Biosciences, AbbVie Farmaceútica, Ability Pharmaceuticals, Agios, Amgen, Aslan, AstraZeneca, Bayer, Beigene, Biolinerx, Blueprint Medicines, Boston Biomedical, Bristol Myers Squibb (BMS), Cantargia, Celgene, Eisai, Erytech Pharma, F. Hoffmann-la Roche, Fibrogen, Genentech, Hallozyme, Immunomedics, Incyte, Ipsen, Lab. Menarini, Lilly, Loxo Oncology, Medimmune, Merimarck, Millenim, Nelum, Novartis, Novocure, Pfizer, Pharmacyclics, Roche, Zymeworks; Non-Financial Interests, Member: American Society of Clinical Oncology - ASCO, “Sociedad Española de Oncología Médica” – SEOM, Sociedad Europea de Oncología Médica - ESMO; Other, Other, Editorial Board: GI Annals og¡f Oncology. D. Dupoiron: Financial Interests, Personal, Advisory Board: Esteve, Medtronic, Grunenthal; Financial Interests, Personal, Leadership Role: Esteve. A. Falcon Gonzalez: Financial Interests, Personal, Advisory Board: Seagen, Novartis, Pfizer, AstraZeneca, Roche, Esteve; Financial Interests, Personal, Invited Speaker: Pfizer, Novartis, Lilly, Grunenthal pharma, Roche, AstraZeneca, Daiichi Sankyo. All other authors have declared no conflicts of interest.