Cancer Pain Overview

Cancer is a leading cause of death globally, with millions of new cases diagnosed each year^3,4,5,6. Pain management in cancer patients has evolved significantly due to advancements in Oncologic care, resulting in patients living longer with improved quality of life. Historically, cancer pain management focused on short-term survival, often using high-dose opioids for comfort. Today, there is a need for pain management strategies that emphasize both symptom control and maintaining functionality as survival rates for many cancers, such as breast and prostate, have increased dramatically⁷.

A significant issue is the undertreatment of cancer pain, which affects an estimated 51% of patients globally⁸. Socioeconomic factors and geographical disparities contribute to differences in pain management strategies^9,10. Effective management is critical given the rising number of cancer survivors, many of whom experience chronic pain due to treatment or disease progression^11,12. Intrathecal Drug Delivery (IDD) is identified as a potent pain management option with strong evidence for efficacy, especially in cancer pain patients^{9,13,14,15,16,17,18}. IDD has shown benefits such as reduced reliance on systemic opioids and improved quality of life^18,19,20. Data shows that IDD is not used often enough in cancer patients and racial and socioeconomic disparities exist²¹. Participation with the treating cancer team and shared risk-benefit discussions with consideration of intrathecal therapy earlier for acute and chronic use and end-of life periods may improve overall patient care²².

Consensus Point 1. The PACC considers IDD as a minimally invasive and potent modality of pain management in carefully selected patients with ongoing cancer pain management needs. USPSTF Grade A; Level of certainty high; Quality of evidence I-B