Bridging Gaps in Cancer Pain Care: Barriers, Solutions, and a Path Forward for Integrated Management

TL;DR

Experts in Italy identified barriers to effective cancer pain management and proposed solutions to improve patient care through better training, teamwork, and standardized protocols.

Contribution

The paper presents a consensus-driven framework to address systemic gaps in cancer pain care through interdisciplinary collaboration and policy alignment.

Findings

Four main barriers to cancer pain management were identified: inadequate training, fragmented care, unclear roles, and implementation challenges.

Proposed solutions include interdisciplinary education, integrated care centers, and adaptable treatment guidelines.

Improved pain management could reduce patient suffering and enhance quality of life through better-coordinated care.

Abstract

Cancer pain affects most patients with advanced disease, yet remains undertreated despite available treatments and guidelines. In Italy, a national meeting of cancer care experts identified four main barriers preventing effective pain management: healthcare providers lack adequate training in pain treatment, different medical teams work separately rather than together, professional roles are unclear, leading to confusion about responsibilities, and standardized care protocols are difficult to implement in practice. The experts proposed solutions including better education for doctors and nurses, creating integrated cancer centers where different specialists work together, clarifying who does what in pain management, and developing flexible treatment guidelines that can be adapted to different hospitals. Additionally, patient misconceptions about pain medications need to be addressed through education. These recommendations could improve pain care for cancer patients by ensuring that healthcare teams are better trained, work together more effectively, and follow consistent approaches to pain treatment, ultimately reducing suffering and improving quality of life.

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients’ quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer.