title: Barriers to pain assessment and management in cancer survivorship.
abstract: BACKGROUND
  Healthcare providers frequently lack the knowledge and skills to provide optimal pain management for cancer survivors. Scientific evidence and clinical guidelines are lacking in the management of chronic, persistent pain in survivors. The purpose of this article is to describe pain-related issues of cancer survivors using case presentations of selected patients enrolled in a randomized trial to eliminate barriers to pain management.
  
  
  METHODS
  Case presentations were selected from a National Cancer Institute-funded study that utilizes patient and professional educational content derived from the clinical guidelines of the National Comprehensive Cancer Network. Case presentation criteria included a pain rating of >or=6 and diagnosis of Stage I, II, or III of the following cancers: breast, colon, lung, or prostate cancer. Cases are presented based on the study's framework of patient, professional, and system-related barriers to optimal pain relief.
  
  
  RESULTS
  Across all three case presentations, barriers such as fear of side effects from pain medications, fear of addiction, lack of professional knowledge of the basic principles of pain management, and lack of timely access to pain medications due to reimbursement issues are prevalent in cancer survivorship.
  
  
  CONCLUSIONS
  Chronic pain syndromes related to cancer treatments are common in cancer survivors. Patient, professional, and system-related barriers that are seen during active treatment continue to hinder optimal pain relief during survivorship.
  
  
  CONCLUSIONS
  Healthcare providers must acknowledge the impact of chronic, persistent pain on the quality of cancer survivorship. Clinical as well as scientific efforts to increase knowledge in chronic pain management will improve the symptom management of cancer survivors.
authors.affiliation: Department of Nursing Research and Education, Division of Population Sciences, City of Hope, Duarte, CA 91010, USA. vsun@coh.org
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.forename: Tami
authors.initials: T
authors.lastname: Borneman
authors.forename: Barbara
authors.initials: B
authors.lastname: Piper
authors.forename: Marianna
authors.initials: M
authors.lastname: Koczywas
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
mesh_terms: D005239:Fear; D006801:Humans; D015994:Incidence; D019359:Knowledge; D054547:National Cancer Institute (U.S.); D009316:National Institutes of Health (U.S.); D009369:Neoplasms / Q000150:complications / Q000503:physiopathology*; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D010465:Perception; D015995:Prevalence; D012008:Recurrence; D017741:Survivors; D014481:United States