Walter B. Forman, MD, FACP

Pain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.

In the 1950s, a group of clinicians, who later would be the forerunners of the discipline to be known as oncology, completed the first clinical trial in acute lymphoblastic leukemia. This beginning led to the formation of a learned society in oncology. In the mid-1980s, the American Board of Internal Medicine recognized the field of oncology by providing a qualifying examination to establish its importance in the development and treatment of cancer. The impressive growth in this field over the past decade evolved through a variety of basic research advances and the introduction of clinical trials.