Cancer pain patients often require more frequent clinic visits and dose adjustments compared to non-cancer patients to achieve effective pain relief. This is because response to antineoplastic therapies can significantly alter nociceptive pain levels. For instance, rapidly regressing tumors may result in reduced pain, requiring dose reductions, whereas progressive disease might necessitate aggressive dose escalation.

While catheter tip inflammatory masses are a safety concern in non-cancer patients, they are less likely to develop in cancer patients due to their shorter life expectancy¹⁷. However, with data showing that a significant proportion of cancer patients live beyond a year after starting IDD, regular screening for granulomas remains essential.

When a patient’s prognosis is limited, it may be practical to exceed standard PACC dose recommendations to extend refill intervals and minimize hospital visits, especially for those transitioning to home hospice care. If survival exceeds expectations, a reassessment to prevent granuloma formation is warranted.

Consensus Point 15: The PACC recommends that more aggressive titration of IDD may be needed in cancer pain management when the disease is rapidly progressive, sometimes exceeding standard PACC recommendations. USPSTF Grade B; Level of certainty low; Quality of evidence II.