Cancer pain management: complexities, trade-offs, and implications for pain management interventions

Abstract

Background Pain is prevalent in cancer, especially as the disease progresses. Cancer pain management (CPM) relies on patient, caregiver, and health care professional (HCP) behaviours, particularly relating to the prescribing and use of opioid analgesics. Behavioural interventions to date have achieved modest effects on pain outcomes. The aim of this study was to explore patient, caregiver, and HCP experiences of CPM and the challenges faced. A second aim was to explore potential areas that digital technology might be used to meet some of these challenges. Methods Semi-structured interviews were conducted with adults with cancer pain, their caregivers, and HCPs. Two professional focus groups were conducted. Interviews and focus groups were recorded, transcribed verbatim, and analysed using Framework and thematic analysis. Findings Interviews were conducted with 14 patients, 6 caregivers, and 19 HCPs. Two focus groups were conducted with 12 multidisciplinary HCPs. Patients were aged between 56 and 76, mean 66 years, all with advanced cancer. Patients described managing competing goals. Patients made trade-offs to balance analgesic side effects (particularly relating to cognitive function and constipation), physical activity, pain levels, and independence. Cancer was described as a “full time job†and patients were already using digital technologies to support knowledge, communication, and personal organisation. Discussion Analgesic use in cancer pain is highly individual and patients make complex decisions to achieve personal pain management goals. By characterising this decision making process, suggestions are made to inform the development of future behavioural interventions. A digital intervention would be feasible in this population.