Pain control in the continuity of care

Abstract

As cancer is earlier diagnosed and its treatments improve, palliative care is increasingly playinga vital role in the oncology population. The concept and the timing of application of palliativecare have evolved in the last decades. The WHO pain ladder and the greater understanding ofappropriate multimodal pain control treatments have dramatically improved the managementof cancer pain. Integration of palliative care, which appears crucial for a proper management ofpatients, can be defined as the provision of palliative care both during curative cancer treatmentand after curative treatment has ceased. Clinical assistance should be delivered by specialisedphysicians in different fields, psychologists and nurses, and should include all aspects of advancedcancercare, from diagnosis to the treatment of symptoms. A further aspect of integration ofpalliative care concerns the role of the continuity of care in acute or emergency contexts bothfor out- and inpatients. Further improvements in the management of cancer pain are needed.First, the WHO ladder should be modified with further steps, like those of interventional paincontrol procedures and techniques, with the aim of being effective also for the small proportion ofnonresponsive patients. Second, more research is needed to find out which interventions aimingto improve continuity of care of cancer patients are beneficial to improve patient, providerand process of care outcomes and to identify which outcomes are the most sensitive to change.Of crucial importance would be the development of a standardised instrument to measure thecontinuity of care in cancer patients.This article is a brief overview on the management of cancer pain, from the pharmacologicaltreatments reported by WHO ladder, to the need for integration and continuity of care.