Cancer Survivors & Cancer Pain

Question 1

Cancer Survivor

Answer 1

Those who have finished primary treatment and are living with or beyond the disease

Question 2

Annual incidence of cancer diagnoses in the UK

Answer 2

375,000

Question 3

How many cancer survivors suffer from chronic pain

Answer 3

10-40%

Question 4

Improvement in cancer survival is due to…

Answer 4

• Earlier detection
• Advances in radiation oncology
• Better surgical techniques
• Personalised systemic anticancer therapy

Question 5

Risk factors for chronic pain in cancer survivors

Answer 5

• Type of cancer: Lymphoma, leukaemia, lung, breast and colorectal cancer
• Age <65yrs
• Cigarette smoking
• Insomnia

Question 6

Causes of pain in cancer survivors

Answer 6

Tumour related
- local mass effect
- Cancer-induced bone pain
- paraneoplastic effects
- Central sensitisation

Treatment-related
- Surgery
- Chemo- & radiotherapy

Assoc Conditions
- Hypercalcaemia
- Osteoporosis
- Prolonged immobility

Question 7

How does radiotherapy cause pain

Answer 7

• Radiation alters gene expression leading to the release of IL-1 and TNF-a triggering inflammation and nociceptor sensitisation
• Radiation can cause direct neuronal damage and demyelination leading to peripheral neuropathy
• Radiation can injure vasculature and cause ischaemic pain

Question 8

Chemotherapy agents implicated in peripheral neuropathy

Answer 8

• Vincristine (alkaloid)
• Cisplatin (platinum compound)
• Paclitaxel (taxane)

Question 9

Immunotherapy modalities

Answer 9

• Monoclonal antibodies - target specific antigens
• Immune checkpoint inhibitors - block surface proteins, restoring immune systems anticancer mechanism
• Adoptive t-cell therapy - train host t cells to kill cancer cells
• Immune system modulators - increase cytokine productions which will destroy cancer cells

Question 10

Topical Agents in Neuropathic Pain

Answer 10

• Menthol cream - TRPM8 agonist
• Capsaicin- TRPV1 agonis
• Local Anaesthetic- EMLA/ AMETOP
• Doxepin- TCA that can be applied topically

Question 11

Botox A injection for chronic pain MOA

Answer 11

• prevents the release of ACh at the neuromuscular junction, helping with MSK pain
• May inhibit the release of Sub P/ glutamate etc and therefore prevent sensory neurone firing

Question 12

Neuromodulation for chronic pain

Answer 12

The use of electricity or biochemicals to alter nerve function
- Acupuncture
- TENS
- Peripheral nerve stimulation
- Spinal Cord Stimulators
- Intrathecal drug delivery