Pain and Cancer
Cancer rehabilitation can help reduce pain
Pain in cancer is very common – approximately 50% of those diagnosed experience pain of at least moderate intensity and it often persists for years into survivorship.1 Pain frequently occurs along with depression, with both having a negative effect on functional status and quality of life. However, pain and depression are often underdiagnosed and undertreated.2-5
Burden on oncologists and primary care physicians

A 2010 study in the Journal of Pain and Symptom Management found pain and depression to cause substantial disability in terms of activity limitation. Patients surveyed spent an average of 60% of days over a four-week period in bed or had activity levels reduced by at least 50%. 43% reported being unemployed due to health reasons.

This study found health care utilization to be high for those with pain and depression, and oncologists and primary care physicians serve as the main providers of symptom-based care for cancer patients and survivors. The use of specialty care for treatment of pain is low.6
Exercise shown to help reduce pain

Recent studies demonstrate that exercise helps decrease pain resulting from cancer and cancer treatments. Here is an overview of some of the research
  1. A recent controlled pilot study examined 28 breast cancer patients undergoing chemotherapy and radiation therapy who had not been engaged in physical training for three months previously. In a renowned cancer treatment center, the study group underwent 12 weeks of training. The results were very encouraging

    ”Patients in the study group showed a significant decrease in total pain points (p = 0.0047), pain intensity (p = 0.0082), and the extent to which pain interfered with their daily life (p = 0.0047).”

    The study concluded that combined training was effective in decreasing pain and increasing VO2 max, flexibility and static strength in patients with breast cancer."7
  2. A recently published broad review of literature examining the potential for physical activity to reduce cancer symptoms and cancer treatment side effects concluded, “evidence suggests positive effects of exercise in most of neoplastic patients suffering from cancer pain and they can take advantage of exercise approach.”8
Cancer survivors express interest in exercise

Recent research has shown that cancer survivors of all ages would like their oncology providers to initiate discussions about exercise. They would also like for them to initiate appropriate referrals.

Researchers suggest that given the benefits of exercise demonstrated by recent research, discussions about exercise and appropriate referrals to a qualified exercise physiologist could significantly improve prognosis, recovery, symptom burden and multiple domains of life in these individuals.9
Guidelines for pain and cancer

The American Society of Clinical Oncology and National Comprehensive Cancer Network’s clinical practice guidelines both refer to physical rehabilitation professionals as appropriate adjunct team members to assist in the screening and treatment of cancer pain.10-11 In particular, ASCO’s guidelines state the following, applicable to utilization of other health care professionals in the management of adult cancer pain:.

  • Be aware of chronic pain syndromes resulting from cancer treatments, the prevalence of these syndromes, risk factors for individual patients, and appropriate treatment options.
  • Aim to enhance comfort, improve function, limit adverse events, and ensure safety in the management of pain in cancer survivors.
  • Determine the need for other health professionals. If deemed necessary, the clinician should define who is responsible for each aspect of care and refer patients accordingly.
  • Physicians may prescribe directly or refer patients to other professionals to provide the interventions…to mitigate chronic pain or improve pain-related outcomes in cancer survivors.
  • Clinicians may prescribe a trial of opioids in carefully selected cancer survivors with chronic pain who do not respond to more conservative management and who continue to experience pain-related distress or functional impairment.
ReVital is a Leader in Cancer Rehabilitation


We have a common goal—to improve your patients’ quality of life. As oncologists, your focus is on life-saving medical interventions. With the growing numbers of survivors, shift to value-based care and a shortage of oncologists, we know you are busy. You have much more than just patient care to manage with limited time and resources to do so.

As cancer rehabilitation therapists, our focus is to support you and your patients by helping to reduce pain and thus optimize function and quality of life through education and various physical rehabilitation interventions. With the current opioid crisis in the US, rehabilitation professionals are perfectly poised to help reduce the impact of pain on many survivors and help improve functional impairments before the opioid trial referenced in ASCO’s guidelines may be needed. ReVital Cancer Rehabilitation therapists have been extensively trained in the unique needs of both patients and oncologists, allowing them to serve as key partners to improve patients’ quality of life while also reducing oncologist burden.
Resources

  1. Marcus D. Eipdemiology of Cancer Pain. Current Pain and Headaches Report. 2011; 15 (4): 231-234.
  2. Fallowfield, L., Ratcliffe, D., Jenkins, V., and Saul, J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer. 2001; 84: 1011–1015.
  3. Sharpe, M., Strong, V., Allen, K. et al. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer. 2004; 90: 314–320.
  4. Cleeland, C.S., Gonin, R., Hatfield, A.K. et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994; 330: 592–5965.
  5. Cleeland, C.S. Undertreatment of cancer pain in elderly patients. JAMA. 1998; 279: 1914–1915.
  6. Kroenke K, Theobald D, Wu J, et al. The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manage. 2010; 40: 327–41..
  7. https://www.ncbi.nlm.nih.gov/pubmed/29625622.
  8. https://doi.org/10.18632/oncotarget.24456.
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512003//.
  10. Paice JA, Portenoy R, Lacchetti C, Campbell T, et. al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016; 34:3325-3345.
  11. National Comprehensive Cancer Network Guidelines Version 2.2018..