WELCOME to the Second Annual Duke Cancer Pain Symposium

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WELCOMEto theSecond AnnualDuke Cancer Pain
Symposium

• Sponsored by
• Duke Cancer Care Research Program

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VISION

• Cancer care that
• treats the patient as a whole person, in mind,
  body, and spirit
• helps the patient travel the full journey of
  cancer (diagnosis through survivorship or end of
  life)
• incorporates the best of medical care into a
  comprehensive, longitudinal, personalized care
  plan and
• optimizes the patients well-being, quality of
  life, and outcomes.

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Why talk about cancer pain?

• 1/6 of cancer patients at diagnosis
• 1/3 of cancer patients undergoing active therapy
• 60-90 of patients with advanced disease
• gt80 of cancer patients with pain have 2 or more
  sites of pain

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Who is at risk?

• Risk of cancer-related pain is related to
• type and stage of tumor
• age
• race and gender
• therapy, especially side effects of chemotherapy
• lack of belief in the patients pain complaint

Abernethy AP, Samsa GP, and Matchar DB. Am J
Managed Care 2003 9 121-134.
Cleeland CS et. al. NEJM 1994 330592-596.
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Is cancer pain unique?

• Comprises nocioception subjective perception
• Presents unique qualities associated with cancer
• Meaning
• Association with cancer, death, punishment,
  challenge, enemy,
• Existential suffering
• Co-occurring noxious symptoms
• Anticipated progression
• Caused, or relieved, by anti-neoplastic therapies
  
• Low risk of addiction

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Physical
TOTAL PAIN
Psychological
Existential
Social
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• Etiologies and experiences of pain are highly
  individual.

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Cancer pain management
Foundation
Individualized Care
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WHO Analgesic Ladder
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Cancer pain management in practice
Basic principles

• analgesic ladder as foundation of care
• individualized therapy
• round-the-clock dosing
• breakthrough dosing
• by mouth, whenever possible
• side effects treated expectantly

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Do guidelines work?
Du Pen SL et al. Implementing Guidelines for
Cancer Pain Management Results of a Randomized
Controlled Trial. JCO 17361-370, 1999.
Worst Pain, p.2
BPI Pain Intensity
Usual Pain, p lt0.02
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When dont the guidelines work?

• More appropriate prescribing of adjuvant drugs
  for algorithm patients (plt0.001)
• Common errors in both groups
• Prescribing prn dosing only
• Underdosing of rescue medication
• Failure to escalate scheduled dose in face of
  escalating pain

Du Pen SL et al. Implementing Guidelines for
Cancer Pain Management Results of a Randomized
Controlled Trial. JCO 17361-370, 1999.
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Adjuvant therapies

• anticonvulsants
• antidepressants
• benzodiazepines
• antihistamines
• steroids
• antibiotics
• radiation
• bisphosphonates

• chemotherapy
• surgery
• neurolytic blocks and neurosurgery
• acupuncture
• relaxation techniques
• exercise
• other

Side effect management
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Agenda

• Lee Jones - exercise
• TJ Gan - acupuncture
• Amy Abernethy neuropathic pain
• Holly Forester-Miller medical hypnosis
• Alexandra DuPont e/Tablets for assessment
• Lydia Mis side effect management
• Tracy Gosselin survivorship concerns
• Yousuf Zafar topic opiates
• Krista Rowe concluding remarks

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• A sincere thank you to our speakers
• As well as the DCCRP team including Laura
  Criscione and Laura Roe
• And thank you to our audience we wouldnt be
  here if it werent for you and the patients that
  we serve