Contributions of Nursing Professionals and Primary Care Physicians in Interdisciplinary Oncology Teams for Cancer Pain Management: An Analytical Review

Henry Riyanto Sofyan; Anne Dina Soebroto; Eunike Novrilia; Ratu Novia Putri Aulia; Daniel Budi Utomo; Liliana Mangkuwerdojo; Erico Mulfiardi; Radja Buntal Sotarduga Simanjuntak; Made Agus Mahendra Inggas

doi:10.19166/lijn.v2i1.10963

著者

Henry Riyanto Sofyan Rumah Sakit Siloam Semanggi
Anne Dina Soebroto Universitas Pelita Harapan
Eunike Novrilia Rumah Sakit Siloam Semanggi
Ratu Novia Putri Aulia Rumah Sakit Siloam Semanggi
Daniel Budi Utomo Rumah Sakit Siloam Semanggi
Liliana Mangkuwerdojo Rumah Sakit Siloam Semanggi
Erico Mulfiardi Rumah Sakit Siloam Semanggi
Radja Buntal Sotarduga Simanjuntak Rumah Sakit Siloam Semanggi
Made Agus Mahendra Inggas Universitas Pelita Harapan

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https://doi.org/10.19166/lijn.v2i1.10963

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Cancer Pain##common.commaListSeparator## Interdisciplinary Teams##common.commaListSeparator## Nursing Professionals##common.commaListSeparator## Primary Care Physicians##common.commaListSeparator## Collaborative Care ##common.commaListSeparator## Palliative Care##common.commaListSeparator## Pain Mechanisms

要旨

Introduction: Cancer-related pain remains inadequately managed in a substantial proportion of oncology patients, despite established clinical protocols. Current systematic evidence indicates that up to 55% of patients experience undertreated pain.³⁵ Interdisciplinary oncology teams — comprising nursing professionals and primary care physicians (PCPs) — are a critical organizational strategy for improving cancer pain management across the care continuum.

Methods: A systematic narrative synthesis was conducted using 30 peer-reviewed sources identified through structured searches of the PubMed, CINAHL, Scopus, and Cochrane databases. Inclusion criteria encompassed studies, reviews, and guidelines published from 2002 to 2025 that addressed professional roles, team structure, barriers, and clinical outcomes in cancer pain management.

Results: Nursing professionals contribute substantially to pain assessment and management through validated instruments, pharmacological and non-pharmacological interventions, patient self-management education, and interdisciplinary advocacy. PCPs facilitate care coordination, ensure analgesic prescribing continuity, and manage the primary–specialty interface. Effective interdisciplinary teams improve patient outcomes through structured communication, clear roles, and integrated care pathways. Persistent barriers include care fragmentation, professional role ambiguity, competency gaps, and regulatory constraints on opioid prescribing.

Conclusions: Although current evidence supports the effectiveness of interdisciplinary approaches to improving cancer pain outcomes, significant gaps remain in comparative effectiveness data, implementation science, and health equity research. Enhanced clinical training, organizational investment, and policy reform are necessary to optimize collaborative cancer pain management across diverse healthcare settings.

Keywords: Cancer Pain, Interdisciplinary Teams, Nursing Professionals, Primary Care Physicians, Collaborative Care, Palliative Care, Pain Mechanisms

##submission.citations##

1. Swarm RA, Abernethy AP, Anghelescu DL, et al. Adult Cancer Pain. J Natl Compr Canc Netw. 2013;11(8):992-1022.

https://doi.org/10.6004/jnccn.2013.0119

2. Paice JA, Portenoy R, Lacchetti C, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(27):3325-3345. https://doi.org/10.1200/JCO.2016.68.5206

3. Oldenmenger WH, Geerling JI, Mostovaya I, et al. A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain. Cancer Treat Rev. 2018;63:96-103. https://doi.org/10.1016/j.ctrv.2017.12.005

4. Goldberg GR, Morrison RS. Pain management in hospitalized cancer patients: a systematic review. J Clin Oncol. 2007;25(13):1792-1801. https://doi.org/10.1200/jco.2006.07.9038

5. Nersesyan H, Slavin KV. Current approach to cancer pain management: availability and implications of different treatment options. Ther Clin Risk Manag. 2007;3(3):381-400. https://pmc.ncbi.nlm.nih.gov/articles/PMC2386360/

6. Jacobsen R, Sjøgren P, Møldrup C, et al. Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag. 2007;3(4):207-214. https://doi.org/10.5055/jom.2007.0006

7. Oldenmenger WH, Sillevis Smitt PAE, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45(8):1370-1380. https://doi.org/10.1016/j.ejca.2009.01.007

8. Hølen JC, Lydersen S, Klepstad P, et al. The Brief Pain Inventory: pain's interference with functions is different in cancer pain compared with noncancer chronic pain. Clin J Pain. 2008;24(3):219-225. https://doi.org/10.1097/ajp.0b013e31815ec22a

9. Marie N, Luckett T, Davidson PM, et al. Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis. Support Care Cancer. 2013;21(12):3529-3537. https://doi.org/10.1007/s00520-013-1995-0

10. Bennett MI, Bagnall AM, José Closs S. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain. 2009;143(3):192-199. https://doi.org/10.1016/j.pain.2009.01.016

11. Osterbrink J, Ewers A, Nestler N, et al. Pain management in patients with cancer: perspectives of various network participants. Schmerz. 2013;27(6):582-589. https://doi.org/10.1007/s00482-013-1305-2

12. Embree AL. The efficacy of implementing a collaborative palliative pain panel team to reduce cancer pain [DNP dissertation]. Allendale (MI): Grand Valley State University; 2024. https://scholarworks.gvsu.edu/dissertations/66/

13. Drudge-Coates L. Improving management of patients with advanced cancer. Patient Prefer Adherence. 2010;4:417-422. https://doi.org/10.2147/PPA.S15017

14. Telford K, Price S, Drahota A. Collaborative working in cancer pain management. Cancer Nurs Pract. 2020;19(3). https://doi.org/10.7748/cnp.2019.e1560

15. Cringles M. Developing an integrated care pathway to manage cancer pain across primary, secondary and tertiary care. Int J Palliat Nurs. 2002;8(5):247-255. https://doi.org/10.12968/ijpn.2002.8.5.10372

16. Alhusayni M, Alshehri A, Alqahtani A, et al. Negotiating Pain Management Between Nurses And Physicians. Rev Diabet Stud. 2024;20(S3):43-48. https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.diabeticstudies.org/index.php/RDS/article/download/922/787&ved=2ahUKEwiRr6zG6ZGUAxWGU2wGHSTFBRAQFnoECBcQAQ&usg=AOvVaw3sa0-_bqAvZhISL9eV7JJe

17. Hutton N, Kneafsey R. A guide to cancer pain management. Br J Community Nurs. 2008;13(10):462-468. https://doi.org/10.12968/bjcn.2008.13.10.31183

18. Guyer RA, Gogineni K, Garg A, et al. Palliative care tumor board: a narrative review and presentation of a novel conference to enhance collaboration and coordination of pain and symptom management for patients with advanced cancer. Ann Palliat Med. 2024;13(1):134-143. https://doi.org/10.21037/apm-22-1366

19. Chaturvedi SK, Chandra PS, Issac MK. The unheard pain of cancer patients. Syst Rev Pharm. 2013;4(1):1-2.

https://dx.doi.org/10.4103/0975-8453.135832

20. Fennell ML, Das IP, Clauser S, et al. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality. J Natl Cancer Inst Monogr. 2010;2010(40):72-80. https://doi.org/10.1093/jncimonographs/lgq010

21. Ehrlich KB. Cancer pain processes in the hospice caring triad: a grounded theory study [dissertation]. University of Massachusetts Amherst; 2017. https://doi.org/10.7275/9907791.0

22. Pieters R, Veerman AJP, Huismans DR. Principles of multidisciplinary management. In: Cancer Concepts: A Guidebook for the Non-Oncologist. 2015. https://doi.org/10.7191/cancer_concepts.1006

23. Giannitrapani KF, Ahluwalia SC, Dobscha S, et al. Cross disciplinary role agreement is needed when coordinating long-term opioid prescribing for cancer: a qualitative study. J Gen Intern Med. 2021;36(9):2610-2616. https://doi.org/10.1007/s11606-021-06747-z

24. Momen N, Barclay S, Lyons M, et al. Managing pain in advanced cancer: a survey of United Kingdom general practitioners and community nurses. J Pain Symptom Manage. 2013;46(6):e1-e3. https://doi.org/10.1016/j.jpainsymman.2012.09.004

25. Hochstenbach LMJ. Self-management support for outpatients with cancer pain: development, feasibility and impact of an eHealth intervention [dissertation]. Maastricht University; 2017. https://doi.org/10.26481/dis.20170630lh

26. Qadire M. An implementation study to improve cancer pain management in Jordan using a case study [dissertation]. 2011. [Gray literature: verify institutional source before final citation] https://research.manchester.ac.uk/en/studentTheses/an-implementation-study-to-improve-cancer-pain-management-in-jord/

27. Hassankhani H, Rahmani A, Kochaki Nejad Z, et al. Enhancing cancer pain self-management: a holistic supporting model. SAGE Open Nurs. 2023;9. https://doi.org/10.1177/23779608231197581

28. Matthiessen PF, Hankemeier U, Scholz OB. Erfahrungsbericht einer interdisziplinär geführten Schmerzambulanz. In: Schmerztherapie bei Tumorpatienten. Berlin: Springer; 1991.

https://doi.org/10.1007/978-3-642-74316-0_3

29. Wang Y, Chen Y, Zhang X, et al. Barriers for nurses providing cancer pain management: a qualitative systematic review. Oncol Nurs Forum. 2023;50(4):348-360. https://doi.org/10.1188/23.onf.348-360

30. Azizoddin DR, Schreiber KL, Beck MR, et al. The 3P-CP model: expanding our conceptualization of cancer pain. Cancer. 2025;131(1):e35571. https://doi.org/10.1002/cncr.70080

31. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136. https://doi.org/10.1126/science.847460

32. Saunders C. The treatment of intractable pain in terminal cancer. Proc R Soc Med. 1963;56(3):195-197. https://doi.org/10.1177/003591576305600322

33. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. https://www.nejm.org/doi/full/10.1056/NEJMoa1000678

34. Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721-1730. https://doi.org/10.1016/s0140-6736(13)62416-2

35. van den Beuken-van Everdingen MH, Hochstenbach LM, Jöbsis E, et al. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016;51(6):1070-1090. https://doi.org/10.1016/j.jpainsymman.2015.12.340

36. Knaul FM, Farmer PE, Krakauer EL, et al. Alleviating the access abyss in palliative care and pain relief. Lancet. 2018;391(10128):1391-1454. https://doi.org/10.1016/s0140-6736(17)32513-8

37. World Health Organization. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: WHO; 2019. https://www.who.int/publications/i/item/9789241550390