Pain control in the continuity of care.

As cancer is earlier diagnosed and its treatments improve, palliative care is increasingly playing a vital role in the oncology population. The concept and the timing of application of palliative care have evolved in the last decades. The WHO pain ladder and the greater understanding of appropriate multimodal pain control treatments have dramatically improved the management of cancer pain. Integration of palliative care, which appears crucial for a proper management of patients, can be defined as the provision of palliative care both during curative cancer treatment and after curative treatment has ceased. Clinical assistance should be delivered by specialized physicians in different fields, psychologists and nurses, and should include all aspects of advanced cancer care, from diagnosis to the treatment of symptoms. A further aspect of integration of palliative care concerns the role of the continuity of care in acute or emergency contexts both for out- and inpatients. Further improvements in the management of cancer pain are needed. First, the WHO ladder should be modified with further steps, like those of interventional pain control procedures and techniques, with the aim of being effective also for the small proportion of nonresponsive patients. Second, more research is needed to find out which interventions aiming to improve continuity of care of cancer patients are beneficial to improve patient, provider and process of care outcomes and to identify which outcomes are the most sensitive to change. Of crucial importance would be the development of a standardised instrument to measure the continuity of care in cancer patients. This article is a brief overview on the management of cancer pain, from the pharmacological treatments reported by WHO ladder, to the need for integration and continuity of care.