Pre-adaptative and adaptative management of multimorphic cancer pain: the keys to optimizing the patient's journey

Julie Fulcrand ¹ Hélène Dewaele ¹ Guillaume Gourcerol ² Florian Scotté ³ DUPOIRON Denis ⁴ Alexis Burnod ⁵ Antoine Lemaire ^1*

• ¹ Centre Hospitalier de Valenciennes, Valenciennes, Nord-Pas-de-Calais, France
• ² Centre Hospitalier Universitaire (CHU) de Rouen, Rouen, France
• ³ Institut Gustave Roussy, Villejuif, Île-de-France, France
• ⁴ Institut de Cancérologie de l'Ouest (ICO), Angers, Pays de la Loire, France
• ⁵ Institut Curie, Paris, Ile-de-France, France

The number of paLents living with cancer has increased and their management has dramaLcally changed, resulLng in major survival improvement. Thus a new paradigm arose with a focus not only on cancer treatments but also on maintenance of the best possible quality of life.Cancer pain is frequent and remains insufficiently relieved, highlighLng the gap between theory and real life, scienLfic skills, and their applicaLon.Cancer pain is mulLmorphic, complex, mulLfaceted, and changes over Lme from diagnosis unLl cure or palliaLve situaLons. These modificaLons result from the interacLon of intrinsic and extrinsic factors that create disrupLons along the cancer care pathway. Pain screening must be systemaLc, and performed by any healthcare professional in contact with cancer paLents at any Lme, in any context. Pain management must be individualized and adapted to each paLent, anLcipated whenever possible by idenLfying disrupLve factors. The classical stepwise process should be abandoned in favor of an integrated model where supporLve care and, in parLcular, pain management, is an integral part of cancer care from diagnosis to survivorship. Interdisciplinary management is necessary, requiring efficient teamwork led by a conductor. As supporLve care plays a key role, it must be implemented in an early and Lmely manner, taking into account different aspects of the paLent's life including physical, psychological, social, and spiritual aspects.