The Neglected 'last mile' to Fight cancer

The five-year survival rate of tumors is an important indicator of a country's tumor diagnosis and treatment ability. The national five-year survival rate available from public data is about 40.5 percent (in 2020), but in the United States it rises to 70 percent (in 2018).

In order to catch up with the gap in survival rate, major tumor screening led by the state is moving forward methodically, and various pharmaceutical equipment enterprises are also making breakthroughs and innovations in radiotherapy, chemotherapy and targeted therapy, pushing China's anti-tumor therapy technology to the international leading level.

The establishment of an effective prevention and treatment system can certainly continue to improve the survival rate of cancer patients, but there are still some deficiencies in this system.

As the absolute subject of every anti-cancer campaign, the quality of life of patients determines the effectiveness of anti-tumor therapy. However, few people care about what patients experience outside of surgery and chemoradiotherapy, and it is difficult to estimate how the appearance of "cancer pain" will change the life of cancer patients.

"Not only to treat the tumor,

To treat a man with a tumor."

Most people recognize that cancer pain only occurs in the advanced stage of cancer, but the data given in the book Diagnosis and Treatment of Refractory Cancer Pain shows that 25% of patients with early stage cancer will develop cancer pain, 33% after treatment and stable stage, and 60% to 80% in the advanced stage.

As long as you have cancer, there is a probability of cancer pain.

For the pain caused by cancer pain, different cancer patients experience different experiences, but the common hidden in each patient's words: this is a kind of unbearable pain.

"It's almost like giving birth to a baby. It starts at the right time of day. It makes you cry, it makes you scream, it makes you die. At first the pain came once a day for half an hour, then for an hour, then for three hours. It was really painful!"

"I'm in so much pain now that I can barely walk, sometimes I can't stand up at all, and then I can't sit down. When sleeping, sometimes a twitch, is a severe pain. Going to the toilet was a severe ordeal. After each trip, my back hurt so much that I cried."

It should be noted that cancer pain is not uncommon in reality. On the contrary, there were 4.57 million cases of new tumors in China in 2020, of which 60% to 80% had experienced severe pain or extreme pain.

Wang Jiejun, director of the Oncology Department of Shanghai Changzheng Hospital, made a comprehensive statement on the negative impact of cancer pain in a speech: "Cancer pain and its accompanying nausea, vomiting, emaciation, and emotional disorders will gradually weaken patients' will to fight cancer, and also lead to reduced compliance with anti-tumor treatment. For example, weight loss is associated with reduced tolerance to treatment, longer hospital stays, and increased adverse effects, which can affect subsequent cancer treatment."

"If we don't manage the cancer pain well, we can't cure the tumor."

Why is cancer pain so hard to treat in China?

In the face of intractable cancer pain, WHO has already proposed the three-step analgesic treatment principle. In this method, painkillers are divided into three steps according to non-narcotic, mild narcotic and narcotic. Based on the use of non-narcotic painkillers (the first step), a small amount of mild narcotic drugs (the second step) and narcotic painkillers (the third step) are added in order when they fail to control pain.

Theoretically speaking, the strict implementation of the three-step analgesic treatment principle, 80% ~ 90% of tumor patients can effectively relieve or even completely relieve the pain symptoms. However, in the empirical study, 31% ~ 65% of cancer pain could not be effectively controlled under the guidance of the three-step analgesic treatment principle. After all, the compliance rate of patients with cancer pain who voluntarily followed the doctor's orders to take analgesic drugs was only 26.14%.

To solve cancer pain, the key is to solve patients' compliance.

There are many factors for poor compliance. The wrong perception of drugs, the wrong perception of pain, the wrong influence of negative emotions, and the lack of reminding and monitoring mechanism may lead patients to refuse to take drugs.

When I was a child, when the injection infusion, parents often encourage us not to be afraid of pain, the pain of crying on the opposite side of the brave. The education was so hard that many patients are still ashamed to talk about pain when they get older and begin to suffer from the disease.

However, in the face of cancer pain, patients' tolerance under the wrong perception will not help to contain the pain, but will cause changes in psychological and emotional behavior, and even damage sensory nerve, forming intractable cancer pain.

"A lot of patients don't see pain as a disease, they see it as a symptom and they think it's OK to put up with it. But when acute pain becomes chronic pain, the whole feeling of pain is completely different. Acute pain is protective, but chronic pain not only does not protect people, but also leads to the damage of the descending nerve and the disorder of the regulatory mechanism." Wang Jiejun director told the arterial network.

What is more serious is the wrong cognition of doctors and patients for medicine.

According to World Health Organization guidelines, opioids (including morphine, oxycodone and hydromorphone) can be used in the first-line treatment of moderate to severe cancer-related pain and can provide good relief for 90% of patients with severe cancer-related pain. However, due to the close association of the drugs themselves with opium poppy and the negative social effects of their abuse, Many patients have an almost instinctive fear of such drugs.

"This painkiller can not be taken for a long time, take a long time will become addicted, then want to quit is difficult, just like drug, although it is better to take now, but in the long run, will rely on drugs to live."

"I heard that this medicine has great side effects and will shorten my life. I feel dizzy after taking this medicine. Before I get cured, I will let this medicine destroy my body."

In addition, how to judge the use of opioids and how to find the best dosage of opioids are also major difficulties faced by domestic medical workers, which leads to their rejection of opioids.

"One time I gave my mom a 40 milligram oxyketone, and she threw up breakfast, lunch, and dinner that day, in jet vomiting, without time to go to the bathroom, and was groggy for the rest of the day. My mother stopped trying to persuade me to take painkillers."

Generally speaking, the lack of understanding of opioids has led to a relatively backward pain management. The International Control Board judges a country's pain management by its consumption of morphine for medical use. China ranked 83rd in 2012, but slipped to 105th in 2019. To revamp cancer pain management in China, changes are not limited to patients.

Only by achieving quantitative assessment of cancer pain,

In order to meet the accurate management of cancer pain

Based on the results, there are two solutions to improve compliance: one is to eliminate the wrong perception of opioids in the general public, and the other is to find effective means for accurate assessment and high-frequency management of cancer pain.

The dissemination of authoritative medical knowledge is usually carried out by expert teams forming consensus, guidelines, and then transmitted to patients face-to-face. However, since the fight against cancer patients cannot be separated from their families, a better way is to use the power of the Internet to spread a wider range of science.

The development of domestic Internet science popularization platforms is relatively mature. Platforms created by Internet enterprises such as Tencent Medical dictionary and Baidu Health Medical dictionary have all launched corresponding information with the support of authoritative experts, which effectively amplifies the transmission range of cancer pain information.

Many doctors are also helping more patients complete cancer pain cognition with their own efforts. For example, Dr. Azizoddin of the University of Oklahoma developed "STAMP", an opioid management APP for patients with advanced cancer pain. It provides patients with medication and non-medication pain self-management knowledge in the form of animated videos, educational texts with visual effects, self-management challenge tests, and recorded relaxation exercises. And provide personalized guidance and recommendations based on the patient's symptom report to meet the patient's needs as accurately as possible.

In this process, the Internet, as a carrier, not only amplifies the spread of cancer pain management knowledge, but also extends the treatment limited to the hospital outside the hospital, so that patients can participate in supervision and education more intuitively and deeply.

However, mere transmission and supervision cannot play an effective role in cancer pain management. After all, evidence for quantitative analysis of cancer pain cannot be found through CT, MR And other image information. Patients can only make qualitative complaints with the help of sensory experience, so the results are often subjective and have time lag. Therefore, in order to judge the differences in the severity of cancer pain at different times, and then give patients reasonable drug dosage, medical staff must achieve a quantitative cancer pain evaluation that meets a certain frequency.

From this perspective, the management of cancer pain is similar to that of deep vein thrombosis (VTE). Both of them need reasonable scale for degree assessment, and also need intelligent tools for frequency supplement. Based on the mature experience of VTE, cancer pain management can integrate out-of-hospital evaluation based on overall intelligent management in the hospital.

In Wang Jiejun's view, cancer pain digital therapy may be able to take into account both needs. With the help of the Internet, the Internet of Things, 5G and other technologies, digital therapy can not only meet the various evaluation requirements of cancer pain management in the hospital, but also realize evaluation and supervision functions outside the hospital, connecting online and offline, in-hospital and out-of-hospital processes to achieve the real sense of cancer pain management.

"Present assessment is important for pain assessment. Through the combination of sleep disorders, emotional disorders, limb dysfunction and other factors for patients to form a systematic, multi-dimensional comprehensive judgment, can dynamically judge the status of patients during treatment, even if the treatment plan adjustment. At the same time, we need this tool to standardize doctors' treatment plans in order to achieve better treatment uniformity for patients.

Talk about the treatment of cancer pain after evaluation. This is a multidisciplinary joint action. Firstly, cancer pain should be regarded as a chronic disease for long-term management and treatment. Secondly, analgesia and pain treatment should be combined for management, and different treatment means should be given according to different situations. Finally, we need to link the hospital and the outside. Many patients are well treated in the hospital, but once outside the hospital, the situation deteriorates dramatically. This requires us to build an effective management platform inside and outside the hospital, which is very important for patients."

In addition, in order to complete the shortcoming of quantitative evaluation of cancer pain, Director Wang Jiejun developed an intelligent pain assessment tool named BTS6D. This tool can help patients assess the intensity of pain and its impact on limb function, emotional sleep and other factors within one and a half minutes, relieve the pressure of shortage of medical resources for cancer pain assessment, complete the "high frequency" shortcomings of traditional cancer pain assessment, and help doctors establish real-time and effective diagnosis and treatment programs.

A study involving 2000 patients from 40 hospitals showed no statistical difference between the BTS6D pain assessment and the traditional pain assessment questionnaire. The accuracy of the BTS6D pain assessment was 98.9%, and the accuracy of the neuropathic pain diagnosis was 97.7%. In addition, BTS had significant advantages in questionnaire filling time, convenience of use and patient preference, and the difference was statistically significant.

It's worth noting that AI-powered algorithms might be able to predict cancer pain before it arrives if pain assessment tools are given richer data. There are already a number of studies that point to this goal, and in the future, patients may be able to fight their tumors without suffering and more gracefully manage their cancer treatment.

The scale of cancer pain management

It takes a lot of help

Although the treatment of cancer pain is only a process of "evaluation + medication", in order to truly implement this logic for patients, each subject of government, hospitals, doctors, patients and even enterprises needs to play a key role in their role.

The enterprise side is the one that is currently in a weak position. Cancer pain management is a potential market, but limited by disease cognition, technical limitations and other difficulties, there are only a handful of participating enterprises willing to take risks.

In terms of interventional treatment after morphine overdose, only the ultrasonic intraperitoneal plexus injection needle developed by Cook in the United States has been approved by NMPA in China, which can block pain nerves in abdominal organs under ultrasonic guidance, and there are very few domestic competitors.

The same goes for digital therapy. Although there are a large number of participants in pain management, overseas companies such as Hinge Health, Kaia Health and N1 -- Headache have operated for ten years, while in China, Xinyun Medical, Hepu Medical and Love Health are thriving. However, compared with muscle pain, migraine and other diseases, the quantitative and evaluation of cancer pain requires higher accuracy, so most enterprises hesitate and do not carry out in-depth research.

But there are opportunities behind the risks. Cancer pain exists, the need for cancer pain management has always existed. With the gradual change of ideas, there will inevitably be more patients involved in the management of cancer pain supported by science. At that time, the potential power of the discipline will be released over time.