Monday, March 27, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for hematologists/oncologists, internists, family medicine/primary care physicians, nurses, nurse practitioners, pharmacists, physician assistants, psychiatrists, hospice and palliative medicine physicians, and other members of the healthcare team for patients with cancer pain.
The goal of this activity is for learners to be better able to describe evidence-based recommendations for practicing cians on integrative approaches to managing pain in patients with cancer, according to a joint guideline from the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO®).
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CME / ABIM MOC / CE Released: 11/18/2022
Valid for credit through: 11/18/2023
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Pain is a leading, disabling symptom among patients with cancer, resulting from tumor burden or invasion of bones, muscles, or nerves. Many cancer treatments, including surgery, chemotherapy, radiotherapy, immunotherapy, or hormonal therapy can result in acute and chronic pain conditions, including aromatase inhibitor (AI)-induced joint pain or chemotherapy-induced peripheral neuropathy (CIPN) pain.
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO®) panel included experts in integrative, medical, radiation, surgical, and palliative oncology; social sciences; mind-body medicine; nursing; and patient advocacy. Literature search identified 227 relevant studies (systematic reviews, meta-analyses, and randomized controlled trials [RCTs] from 1990 to 2021 to inform consensus- and evidence-based recommendations.
New guidelines highlight the role that integrative pain management techniques, such as massage, acupuncture, and music therapy, can play in relieving certain types of cancer pain in adults.
The recommendations,[1] published earlier this month in the Journal of Clinical Oncology, represent a joint effort between the American Society of Clinical Oncology (ASCO®) and the Society of Integrative Oncology (SIO) to guide cliniciansicians how to best weave various nonpharmacologic pain management strategies into cancer care.
"Pain is a clinical challenge for many oncology patients and clinicians, and there's a growing body of evidence showing that integrative therapies can be useful in pain management," Heather Greenlee, ND, PhD, explained in a press release.[2]
Still, clear clinical guidance as to when and when not to use these approaches is lacking, said Greenlee, co-chair of the SIO Clinical Practice Guideline Committee.
Previous guidelines from ASCO® on managing chronic cancer-related pain[3] largely focused on diagnosing pain and on pharmacologic interventions, and they only touched on evidence related to nonpharmacologic options.
The new guideline[1] "takes a deeper dive on the use of integrative therapies, which is important because clinicians and patients need to have access to the latest evidence-based information to make clinical decisions," Jun H. Mao, MD, SIO-ASCO® panel co-chair, noted.
In the guidance, the expert panel addresses 2 core questions: What mind-body therapies are recommended for managing pain experienced by adult and pediatric patients diagnosed with cancer, and what natural products are recommended for managing pain experienced by adult and pediatric patients diagnosed with cancer?
The panel conducted a literature search and identified 227 relevant studies. They included systematic reviews and randomized controlled trials published between 1990 and 2021 that evaluated outcomes related to pain intensity, symptom relief, and adverse events. After reaching a consensus, the expert panel made recommendations on the basis of the strength of the available evidence.
Regarding modalities for which there was stronger evidence, the panel highlighted several recommendations regarding acupuncture, reflexology, hypnosis, and massage.
The panel determined, for instance, that acupuncture should be offered for aromatase-related joint pain in patients with breast cancer and that it can be offered for general or musculoskeletal pain from cancer. It recommended reflexology or acupressure for pain experienced during systemic therapy for cancer.
Hypnosis is an option for patients experiencing procedural pain in cancer treatment or diagnostic workups, and massage is an option for pain experienced during palliative or hospice care or after breast cancer treatment.
These recommendations were considered moderate in strength and were based on intermediate levels of evidence that demonstrated that the benefits outweighed risks.
The panel added several recommendations it deemed to be weak in strength and that were based on low-quality evidence. These include Hatha yoga for patients experiencing pain after treatment for breast or head and neck cancers, and music therapy for patients experiencing pain from cancer surgery.
The experts also identified areas "potentially relevant to cancer care but needing more research," such as the safety and efficacy of natural products, including omega-3 fatty acids and glutamine, and determined that there is insufficient or inconclusive evidence to make recommendations for pediatric patients.
"With improved oncology treatments such as immunotherapy and targeted therapy, more patients diagnosed with cancer are living longer; therefore, pain and symptom management is critical for improving quality of life," Mao, chief of integrative medicine at Memorial Sloan Kettering Cancer Center, New York, New York, told Medscape Medical News. "The SIO-ASCO clinical guideline will provide very timely recommendations for physicians to incorporate nonpharmacological treatments such as acupuncture and massage to improve pain management for patients impacted by cancer."
Nonetheless, clinical uptake of such treatments "is always a concern," said panel co-chair Eduardo Bruera, MD, of The University of Texas MD Anderson Cancer Center, Houston, Texas. "We are hoping that by showing the growing evidence that is out there, healthcare systems will start hiring these kinds of practitioners and insurance systems will start covering these treatments, because more and more, these are being shown to be effective at managing pain for cancer populations," Bruera said.
The SIO-ASCO® panel’s work was supported by a grant from the Samueli Foundation to the Society for Integrative Oncology.
