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Andrea M. Trescot

Cancer pain is unfortunately very prevalent, with opioids the mainstay of treatment. Knowledge of the types of pain caused by cancer and the effects of various opioids would be expected to improve pain therapy. This article addresses the use, side effects, formulations, and metabolism of the most commonly used opioids in cancer pain management, including morphine, codeine, hydrocodone, hydromorphone, fentanyl, and methadone. The role of opioid conversion and equipotent dosing when changing from one opioid to another is also described.

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Since 2000, NCCN has offered the Fellows Recognition Program as an educational program just prior to the NCCN Annual Conference. The purpose of this program is to educate future oncology leaders about the application of the NCCN Clinical Practice Guidelines in Oncology to the management of major cancer types and supportive care areas. In 2008, NCCN again offered a half-day program for oncology fellows, entitled “New Horizons in Quality Cancer Care,” this year adding an award component—the NCCN Fellows Award—for the best proposals for new concepts in advancing the quality of cancer care. 2008 NCCN Fellows Award recipients are: Benjamin J. George, MD, from Wilford Hall Medical Center, Lackland Air Force Base, for An Integrative Approach to Pain Management in Patients with Advanced Cancer Kimberly A. Jones, MD, from Huntsman Cancer Institute at the University of Utah, for Utilization of Performance Status in Patient Care: How Physicians Measure Up Kilian Salerno May, MD, from Roswell Park Cancer Institute, for On Target? A Quality Initiative to Evaluate Accuracy of Electronic Portal Imaging for Set-Up Verification in Radiotherapy Susan A. McCloskey, MD, from Roswell Park Cancer Institute, for Establishment of Methodologies for the Use of Administrative Insurance Claims in Case Identification and Evaluation of Care Delivered to Newly Diagnosed Prostate Cancer Patients Sumanta Kumar Pal, MD, from City of Hope, for Referral of Oncology Patients for Routine Cancer-Related Screening: An Institutional Quality Improvement Initiative An Integrative Approach to Pain Management in Patients with Advanced Cancer Benjamin J. George, MD, Wilford Hall Medical...
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Michael D. Stubblefield, Harold J. Burstein, Allen W. Burton, Christian M. Custodio, Gary E. Deng, Maria Ho, Larry Junck, G. Stephen Morris, Judith A. Paice, Sudhakar Tummala and Jamie H. Von Roenn

Neuropathy is a common, often debilitating complication of cancer and its treatment. Effective management of this disorder depends on early diagnosis and an understanding of its underlying causes in the individual patient. In January 2009, NCCN gathered a multidisciplinary group to review the literature and discuss intervention strategies currently available to patients as well as areas that require research efforts. The task force, which comprised experts in anesthesiology, medical oncology, neurology, neuro-oncology, neurophysiology, nursing, pain management, and rehabilitation, was charged with the goal of outlining recommendations for the possible prevention, diagnosis, and management of neuropathy. This report documents the proceedings of this meeting with a general background on neuropathy and neuropathy in oncology, followed by discussions on challenges and research issues, evaluation criteria, and management of different symptoms associated with this disorder.

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Jimmie C. Holland and Barry D. Bultz

Psychosocial care of patients has traditionally been seen as separate from routine medical care and has been criticized as being “soft” and lacking evidence. This traditional perspective continues in many settings, despite the fact that patients and families, when asked, state that emotional care is highly valued. The question of how to integrate psychosocial care into routine cancer care has also been an issue, partly because of the stigma associated with cancer.In 1997, the National Comprehensive Cancer Network (NCCN) established a multidisciplinary panel to examine this problem.1 Because patient and physician attitudes toward pain can pose similar barriers to care as can distress, the panel used as a model the rating system for assessing pain that resulted in successful improvement of pain management in the United States. The rating system's success seemed partly based on routinely using a single question to assess a patient's pain: “How is your pain on a scale of 0 to 10?” The system uses a score of 5 or higher as the indication to reassess pain medications or refer the patient for more expert management. This system is widely used, and patient self-report of subjective symptoms is now accepted as appropriate and reliable. Pain has become the fifth vital sign, after pulse, respiration, blood pressure, and temperature, ensuring that it is evaluated as part of routine care.Drawing on this experience, the NCCN panel recommended a simple question to ask patients about psychosocial concerns. They found that distress was the best umbrella word to...
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Lisa M. Stearns, Shane E. Brogan, Krisstin Hammond and Robert J. Spencer

Introduction World Health Organization guidelines identified inadequate cancer pain management as a global health concern, with the analgesic ladder developed to support stepwise progression to strong opioids as necessary. The 2018 National

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Updates in Version 2.2013 of the NCCN Guidelines for Adult Cancer Pain from Version 2.2012 include: PAIN-1 Principles of Cancer Pain Management 1st bullet was modified as: “There is increasing evidence in oncology that survival is linked to

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Judith A. Paice

“ Unrelieved pain is a public health crisis, and opioid misuse and overdose deaths are emergencies. These 2 crises have converged, and unintended consequences of efforts to squelch the opioid crisis have led to challenges in pain management

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Raymond b MD Serrie Alain c MD, PhD 03 2013 11 11 suppl_1 suppl_1 S-11 S-11 S-16 S-16 011S-11 10.6004/jnccn.2013.0209 Provision of Palliative Care and Pain Management Services for Oncology Patients Marchetti Paolo a MD Voltz Raymond

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Nora Janjan

compared with only 37.2% of the group whose pain was not as well controlled ( P =.06). Therefore, given the influence of pain as an independent predictor for survival, pain management, like hematologic parameters, should be controlled for in the conduct and

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Pain Management: Important Adjuvants to Systemic Analgesics Eidelman Anthony MD White Traci MD Swarm Robert A. MD 09 2007 5 5 8 8 851 851 858 858 0050851 10.6004/jnccn.2007.0075