CCSN held its fifth All-party Cancer Caucus at Queen’s Park in Toronto on December 5, 2019. Once again, we provided MPPs and their staff information on an issue related to rehabilitation for cancer survivors – sporadic and chronic pain. Alexander Wyatt, CCSN’s Public Policy Coordinator, and Owen Brady, CCSN’s Partnerships and Fundraising Manager, hosted the event. Speakers included Jennifer Jones, PhD, who spoke on cancer survivorship and rehabilitation (https://youtu.be/nwxzBvErBqE); Dr. David Flamer, who provided information on cancer pain management (https://youtu.be/yaYGeOojS2M). These two speakers were followed by Vinesha Ramasamy, a bone cancer survivor, who spoke about her chronic pain journey (above) and John Peachey, a stage 4 lung cancer survivor who was unable to attend, but asked that his experience with pain medications be read (https://youtu.be/2M6gS6OZiHk). For the first time and with the permission of the speakers, CCSN was able to video the Caucus. We are pleased to share them with you. To view the slide go on: http://bit.ly/36T4DmX Follow CCSN on social media: Twitter - https://twitter.com/survivornetca Facebook - https://www.facebook.com/CanadianSurvivorNet Instagram: https://www.instagram.com/survivornet_ca/ Pinterest - https://www.pinterest.com/survivornetwork

1. Cancer Pain Management:
Specialized Care
Dr. David Flamer, MD FRCPC
Assistant Professor, University of Toronto
Department of Anesthesia and Pain Management
Co-Director, Cancer Pain Clinic, Princess Margaret Hospital
Associate Director, Wasser Pain Management Clinic, Mount
Sinai Hospital
david.flamer@uhn.ca

2. • Significant improvement in cancer mortality over past 30
years has led to refractory pain being an important
consequence
✓ Direct tumor invasion
✓ Metastatic bone pain
✓ Visceral distention, obstruction
✓ Nerve compression and infiltration
✓ Chemotherapy-related
✓ Radiation-related
✓ Post-surgical pain
Paice JA, Von Roenn JH. Under- or overtreatment of pain in the patient with cancer: How to achieve proper balance. J Clin Oncol. 2014
What causes cancer pain?

3. What causes cancer pain?

4. American Cancer Society
Cancer Survivors by Site

5. WHO 3-Step Analgesic Ladder

6. “Despite the clear WHO recommendations, cancer pain still is a major problem”
Epidemiology of Cancer Pain

7. •WHO Cancer Pain Ladder for Adults can effectively manage 80-
90% of cancer pain
•10 - 20% have inadequate pain relief despite comprehensive
medical management
•Evidence shows that early access can decrease pain scores and
improve quality of life
•Current opioid crisis further highlights the importance of
incorporating novel pain management strategies
Burton et al. Chronic pain in the cancer survivor: A new frontier. Pain Med. 2007
Amr et al. Neurolytic sympathectomy in the management of cancer pain - Time effect: A prospective, randomized multicenter study. J Pain
Symptom Manage. 2014
Lema MJ. Invasive analgesia techniques for advanced cancer pain. Surg Onc Clin N Am. 2001
Cancer Pain: A Challenging Problem

8. Opioid Crisis:
Recent Challenges in Cancer Patients

9. Distinctive features of cancer pain:
• Unique causes and overlapping types of pain
• Severity is dynamic and fluctuates throughout
treatment
• Both acute and chronic pain concerns
• Differing goals of care (palliative vs not)
• Multiple specialists, multiple medical co-
morbidities, complex medications
Cancer Pain ≠ Chronic Pain

10. Need for Specialized Cancer Pain
Management

11. Available in Ontario (limited
access)
• Peripheral nerve injections
• Nerve destruction
techniques
• Vertebral augmentation
• Spinal cord stimulation (+++
limited)
Health Canada approved – not
funded in ON
• Peripheral nerve stimulation
• Neuraxial therapy
(intrathecal and epidural
drug delivery)
Novel Therapies for Cancer Pain

12. 19, 03/15/19 © 2019 National Comprehensive Cancer Network®
(NCCN®
), All rights reserved. NCCN Guidelines®
and this illustration may not be reproduced in any form without the express written permission of NCCN.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®
)
Adult Cancer Pain
Version 2.2019 — March 15, 2019
Continue
NCCN.org
Role of Multidisciplinary Cancer Pain Management:
Local and International Guidelines