Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov 1;33(11):1001.
doi: 10.1007/s00520-025-09997-3.

Multidisciplinary management of persistent severe cancer pain: a collaborative European approach

Denis Dupoiron  1 , María Luz Padilla  2 , Monica Iorfida  3 , Alejandro Falcon  4 , Matthew R D Brown  5 , Christophe Perruchoud  2 , Xander Zuidema  6 , Vittorio Guardamagna  7 , Carlos Tornero  8 , Christoph Hoefing  9 , Somnath Bagchi  10 , Debora Van Keulen  11 , Rita Kortbaoui  12 , Teresa Macarulla  13 , Mario Di Palma  14
Affiliations

Multidisciplinary management of persistent severe cancer pain: a collaborative European approach

Denis Dupoiron et al. Support Care Cancer. .

Abstract

Purpose: Cancer pain is often undertreated, with patients frequently referred late to specialist services. This study aimed to develop expert-led recommendations to address unmet needs in the management of persistent severe cancer pain in Europe.

Methods: An online questionnaire on cancer pain management was used to identify controversies in the clinical practice of European oncologists. A series of recommendations to address these controversies was then proposed and validated, using a Delphi-like methodology, by a joint expert panel of pain specialists and oncologists.

Results: Consensus was reached on 13 recommendations. Key agreements focused on the following: (i) collaboration: establishing cancer pain committees (87% agreement) and shared protocols (100%), (i) education: implementing telematic consultations (100%) and training sessions for oncologists (100%) and (iii) referral: establishing clear referral criteria (100%) for patients with poor quality of life (QoL) (100%) or persistent pain, regardless of aetiology (87-100%), to ensure timely access to specialist care.

Conclusion: Effective cancer pain management necessitates enhanced collaboration between specialties, targeted education for oncologists, and locally co-created protocols with clear referral criteria. These measures are essential to ensure that patients are referred to pain specialists in a timely and appropriate manner, which is crucial for improving their QoL.

Keywords: Cancer pain; Clinical practice; Delphi-like methodology; Oncology expert; Pain specialist; Persistent severe pain.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: Ethics approval was not required for this study. This study is based on clinical practice reported by Pain and Oncology specialists through an online questionnaire and does not present data from any study involving human or animal participants conducted by any of the authors. Consent to participate: Participation in this study was voluntary. All physicians who completed the questionnaire provided consent for the use of their responses in the subsequent analysis prior to completing the questionnaire. All participants involved in the Delphi-like methodology provided verbal informed consent prior to their inclusion in the study. Confidentiality and anonymity of participant responses were strictly maintained throughout the study to protect their privacy. No personal identifying information was collected or shared during the research process. Competing interests: Somnath Bagchi reports membership of Advisory Board for Intrathecal Drug Delivery Team sponsored by Medtronic, travel sponsorship from Esteve; honorarium for delivering lectures by Medtronic; attendance cadaver course sponsored by Boston-Scientific, and neuromodulation meeting sponsored by NEVRO. Matthew R D Brown has received honoraria from Medtronic, Boston Scientific and Astellas and travel expenses from Curonix. Mario Di Palma reports investigator roles with AstraZeneca, Ipsen, Janssen, Novartis, Pierre Fabre, Sandoz; financial relationships with Bayer, Fresenius; advisory board of AstraZeneca, ESTEVE, Fresenius Kabi, Janssen, Mundipharma, Pfizer, Roche, Sandoz, ViiV Healthcare; invited speaker of Amgen, Astellas, BMS, Gilead, Ipsen, Kyowa Kirin, Lilly, Merck, MSD, Mundipharma, Novartis, Resilience, Roche; masterclass with Beigene, Daiichi Sankyo; preceptorship roles with Sandoz; travel expenses from Viatris; member of Ethical Committee of the French National League against Cancer; and member of board of directors of French Speaking Association for Supportive Care in Cancer. Denis Dupoiron reports personal fees from Grunenthal, Medtronic and Esteve. Alejandro Falcon reports advisory board of Roche, Pfizer, Menarini, AstraZeneca, MSD, ESTEVE; invited speaker of Roche, Pfizer, Novartis, Lilly, AstraZeneca, MSD, Gilead, Daiichi, Dr Reddy, Grünenthal; travel accommodations of Novartis, Daiichi, Gilead. Christoph Hoefing reports lecture fee from Medtronic, and invitation to further training from Esteve. María Luz Padilla del Rey reports investigator roles with Esteve, Medtronic; invited speaker of Medtronic, Boston Scientific, Abbott, Grünenthal; proctor of Medtronic; president of the Murcian Pain Society. Christophe Perruchoud reports consultant roles for Medtronic, Esteve; advisory boards of Medtronic, Esteve; invited speaker of Medtronic, Esteve; past President of the Swiss Neuromodulation Society. Carlos Tornero reports investigator roles with AstraZeneca, Boston Scientific, Abbott, Medtronic, Esteve; advisory board of ESTEVE, Altan Pharma; invited speaker of Abbott, Astra Zeneca, Prim, Medtronic, Boston; preceptorship roles with Abbott; President Spanish Society Neuromodulation. Vittorio Guardamagna, Monica Iorfida, Teresa Macarulla, and Debora Van Keulen do not report conflict of interests. Rita Kortbaoui, and Xander Zuidema declare no conflict of interests.

References

    1. Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229–263. 10.3322/caac.21834 - PubMed
    1. Corriero A, Giglio M, Soloperto R (2025) The missing link: integrating interventional pain management in the era of multimodal oncology. Pain Ther. 10.1007/s40122-025-00755-1 - PMC - PubMed
    1. Pérez C, Quintanar T, García C et al (2023) Cancer-related pain management in suitable intrathecal therapy candidates: a Spanish multidisciplinary expert consensus. Curr Oncol 30(8):7303–7314. 10.3390/curroncol30080530 - PMC - PubMed
    1. Bennett MI, Eisenberg E, Ahmedzai SH (2019) Standards for the management of cancer-related pain across Europe-a position paper from the EFIC task force on cancer pain. Eur J Pain 23(4):660–668. 10.1002/ejp.1346 - PMC - PubMed
    1. van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA (2016) Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 51(6):1070–1090.e9. 10.1016/j.jpainsymman.2015.12.340 - PubMed

LinkOut - more resources