Pain is one of the most common clinical symptoms of cancer patients, which seriously affects the quality of life of patients. Drug therapy is an important part of cancer pain treatment, and the rational use of existing drugs and treatment knowledge can alleviate cancer pain in most patients [1]. With the deepening of people's understanding of the pathogenesis of cancer pain and the progress of drug clinical research, the concept and mode of cancer pain drug treatment are also developing. At the 6th CSCO Annual Conference on Cancer Support and Rehabilitation and the 19th National Conference on Cancer Rehabilitation and Palliative Medicine, Professor Chen Yuan from Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology was invited to talk about the progress of cancer pain drug treatment and treatment strategies.
Professor Chen Yuan
Cancer pain medications and delivery methods are constantly evolving
It is an important basis for individualized medication management of cancer pain
Cancer pain, or cancer pain for short, is one of the most common and unbearable major complications of cancer patients, which seriously affects the overall quality of life of patients and brings a heavy mental and economic burden to their families and society. The treatment of cancer pain is a comprehensive treatment, including etiology, drugs, and non-drug treatments, and involves publicity and education for patients and their families, among which drug therapy is the main means of cancer pain treatment [2,3]. The stepped analgesia concept proposed by the World Health Organization (WHO) guides clinicians to adopt a systematic and individualized approach to pain management, and opioids remain the cornerstone of moderate to severe pain management (Figure 1) [4].
With the deepening of the understanding of the pathogenesis and pain assessment of cancer pain, the connotation of the concept of cancer pain drug treatment is also changing. With the continuous emergence of oxycodone extended-release tablets, fentanyl transdermal patches and hydromorphone extended-release tablets that will be launched this year, the drug options for clinicians have been broadened.
In recent years, new models such as intravenous, nasal analgesia, and intrathecal drug infusion system implantation (IDDS), especially the introduction of patient-controlled analgesia (PCA) technology, have played an important role in the rapid titration and management of explosive pain in patients with moderate to severe cancer pain [5].
More drug selection and administration methods are an important basis for doctors to individualize analgesia for cancer pain patients, which can not only improve the analgesic effect, but also better prevent and control adverse drug reactions.
Fig.1 WHO four-step analgesic therapy
A new mode of PCA titration
Escort for patients with moderate to severe cancer pain
The goal of current pain management is to reduce the level of pain to a level acceptable to the patient, and early analgesia is one of the measures to achieve this goal. Therefore, it is important to seek drugs and modalities for patients with moderate to severe cancer pain and acute pain that have a rapid onset of action, a short duration of action, a good tolerability, and few adverse reactions [1].
Opioids are the drug of choice for moderate to severe pain treatment. But the efficacy and safety of opioids vary from patient to patient and from drug to drug, and the correct dose is the dose that reduces the patient's pain to an acceptable level, so the process of opioid titration is the process of finding the appropriate analgesic dose for the individual patient. During titration, patients with moderate to severe cancer pain can be titrated with immediate-release opioids or with extended-release opioids as a background and titrated with instant-release opioids for flare-up pain (Fig. 2) [6].
Figure 2 Titration process for sustained-release opioids in the background
With the application of PCA technology in patients with moderate to severe pain, new models are constantly being explored and improved. The just-concluded American Society of Clinical Oncology (ASCO) meeting released the latest research results of Professor Chen Yuan's team [7], which explored the efficacy and safety of subcutaneous PCA technology and oxycodone extended-release tablets, aiming to provide evidence-based medical evidence for rapid titration of PCA and provide a better titration method for patients with moderate to severe cancer pain.
Studies have shown that subcutaneous PCA can significantly shorten the titration time and achieve analgesia quickly compared with conventional oxycodone extended-release tablets. In addition, one of the highlights of the study was that the dosage of opioids was not increased when switching to extended-release dosage forms, and opioid-related adverse reactions were not increased, despite the rapid titration using PCA technology. Therefore, the rapid titration of PCA technology in patients with moderate to severe cancer pain has a rapid onset of effect, and also provides clinicians with a better choice of titration methods.
Expert Profile
Prof. Yuan Chen, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Visiting Scholar in the Department of Radiation Oncology, MD Anderson Cancer Center, USA
Major Societies/Associations:
Executive Director of China Association for the Promotion of International Exchange in Health Care
Chairman of the Tumor Palliative Care Branch of the China Association for the Promotion of International Exchange in Health Care
Member of the Oncologist Branch of the Chinese Medical Doctor Association
He is a member of the Multidisciplinary Diagnosis and Treatment Committee of the Chinese Medical Doctor Association
He is the deputy leader of the Tumor Support and Rehabilitation Therapy Group of the Oncology Branch of the Chinese Medical Association
He is a member of the Lung Cancer Expert Committee of the Oncology Branch of the Chinese Medical Association
Director of the Chinese Society of Clinical Oncology (CSCO).
Member of the Standing Committee of the CSCO Support and Rehabilitation Expert Committee
He is a member of the Radiotherapy Professional Committee of the Chinese Anti-Cancer Association
He is a member of the Lung Cancer Professional Committee of the Chinese Anti-Cancer Association
Vice Chairman of the Tumor Immunotherapy Committee of the China Medical Education Association
Vice Chairman of the Oncologist Branch of Hubei Medical Doctor Association
Chairman of the Cancer Rehabilitation and Palliative Care Professional Committee of Hubei Anti-Cancer Association
Chairman of the Support and Rehabilitation Treatment Expert Committee of Hubei Provincial Society of Clinical Oncology
Bibliography:
[1] Li Wenjie, Liu Jinyu, Si Qian, et al. Herald of Medicine,2021,40(01):45-51.)
[2] Scarborough Bethann M,Smith Cardinale B. Optimal pain management for patients with cancer in the modern era. [J]. CA: a cancer journal for clinicians,2018,68(3).
[3] Beijing Center for Quality Control and Improvement of Pain Treatment. Chinese Journal of Pain Medicine,2019,25(11):801-807.)
[4] Hachimi-Idrissi S, Coffey F, Hautz WE, et al. Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines-part 1: assessment[J]. Intern Emerg Med. 2020 Oct; 15(7):1125-1139.
[5] Refractory Cancer Pain Group, Cancer Rehabilitation and Palliative Care Professional Committee of Chinese Anti-Cancer Association, Cancer Pain Group, Chinese Society of Pain Branch. Expert consensus on cancer outbreak pain (2019 edition)[J].Chinese Journal of Clinical Oncology,2019,46(6):267-271.)
[6] Bao Yangyi, Cheng Xianping, Hu Bing, et al. Anhui Medicine,2020,24(05):1041-1047.)
[7] https://conferences.asco.org/