Unfortunately, some cancer survivors with chronic cancer-related pain meet significant barriers limiting their access to medications previously determined effective and well-tolerated. An unintended consequence is pain that had been well controlled during active cancer treatment becomes inadequately managed, resulting in unnecessary suffering. The American Academy of Hospice and Palliative Medicine (AAHPM) and the American Pain Society (APS) have provided guidelines to manage pain in cancer patients and survivors. Although the guidelines do reflect variations, the goal should be not to discontinue opioids, but to thoroughly assess the patient's pain and arrive at an appropriate management plan. Long-term opioid use may be necessary to treat cancer-related or non–cancer-related pain in cancer survivors. If opioids are to be initiated or continued, then the approach is to optimize their risk–benefit ratio through monitoring clinical effectiveness, addressing side effects, and monitoring adherence.
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