Pain and Symptom Management
Symptom management is at the core of our care for patients with cancer. When their symptoms are not controlled, it is difficult to explore any other areas of distress, psychological, spiritual/existential, or emotional. Here you’ll find links to books and websites for assessment and management of all the common symptoms experienced by cancer patients, and newsletters and articles that discuss particularly challenging topics.
Looking for something specific? Try the search bar below.
Pain and Symptom Management Topics:
Introduction
Palliative Care - General
Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer
Johns Hopkins University Press. 2022
The full bibliography for Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer
Johns Hopkins University Press. 2022
Development of a Palliative Care Toolkit for the COVID-19 Pandemic
Journal of Pain and Symptom Management 2020;60:e22-e25. S0885-3924(20)30425-5
How Supportive and Palliative Oncology Partnerships Provide Lifesaving Answers
Clinical Oncology: Independent News for the Oncologist and Hematologist/Oncologist. June 2024
Non-Pharmacologic Therapies for Pain Management in Patients With Cancer: Opportunities and Challenges
Onc Live, May 2024
Clinician perspectives on delivering primary and specialty palliative care in community oncology practices.
Support Care Cancer 2024;32:627.
What’s New in Supportive Oncology for Patients with Breast Cancer
October 2025
https://www.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/palliative-care-oncology
bioethics.northwestern.edu/programs/epec
pinkbook.dfci.org
pallmed.net
Redefining Palliative Care and The Role of Supportive Care in Cancer Treatment with Dr. Janet Abrahm
November 17, 2024
Palliative Care: Improving patient care, integrating mental health with Dr Janet Abrahm
May 30, 2024
Anxiety and Depression
Management of anxiety and depression in adult survivors of cancer: ASCO guideline update.
J Clin Oncol 2023;41:3426-3453.
Integrating oncology care of symptoms of anxiety and depression in adults with cancer: society for integrative oncology—ASCO guideline.
J Clin Oncol 2023;41:4562-4591.
Mindfulness and Tai Chi for Cancer Health (MATCH) study: primary outcomes of a preference-based multisite randomized comparative effectiveness trial.
J Clin Oncol 2025;43:2372-2386
The effect of music therapy on anxiety, depression, pain and sleep quality of lung cancer patients: a systematic review and meta-analysis.
Support Care Cancer 2025;33:169
Effects of cognitive behavioral digital therapeutic on anxiety and depression symptoms in patients with cancer: a randomized clinical trial.
JCO Oncol Pract 2023;19:1179-1189.
Cannabis
The impact of cannabis on immune checkpoint inhibitor therapy:a systematic review of immunomodulator effects of cannabis in patients with and without cancer.
Support Care Cancer 2025;33:166
Cannabis and cannabinoids in adults with cancer: ASCO guideline.
J Clin Oncol 2024;42:1575-1593.
Cannabis and cannabinoids in adults with cancer: Guideline Q & A
J Clin Oncol Pract 2024;20:667-770.
Comments from Dr. Abrahm:
While cannabis is not indicated to treat cancer, the Guidelines state that it “may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant anti-emetic regimens.” More research for other indications is urged, as whether it improves other symptoms is uncertain. CBD at 300 mg a day or more causes reversible liver enzyme elevations and may interfere with buprenorphine and tacrolimus metabolism.
Efficacy of cannabinoids for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis.
Support Care Cancer 2025;33:193
MASCC guidelines: cannabis for psychological symptoms including insomnia, anxiety and depression.
Support Care Cancer 2023;31:176. Note: Only abstract content is available.
Comments from Dr. Abrahm:
MASCC guidelines 2023: counsel against its use for psychological symptoms in cancer until the evidence improves, or cancer pain.
Cannabis or Cannabinoids for management of chronic noncancer pain: best practice advice from the American College of Physicians.
Ann Intern Med 2025;178:714-724
MASCC guideline: cannabis for cancer-related pain and risks of harms and adverse events.
Support Care Cancer 2023;31:202. Note: Only abstract content is available.
Comments from Dr. Abrahm:
MASCC guidelines 2023: counsel against its use for psychological symptoms in cancer until the evidence improves, or cancer pain.
Cannabis Use in Patients with Cancer: A Clinical Review
J Oncol Pract 2022; 18:743-752.
Comments from Dr. Abrahm:
While cannabis is not indicated to treat cancer, the Guidelines state that it “may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant anti-emetic regimens.” More research for other indications is urged, as whether it improves other symptoms is uncertain. CBD at 300 mg a day or more causes reversible liver enzyme elevations and may interfere with buprenorphine and tacrolimus metabolism.
Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Effects of intermittent hand-foot hypothermia therapy on chemotherapy-induced peripheral neuropathy.
Support Care Cancer 2025;33:43
Efficacy of cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis
Support Care Cancer 2024;32:482
Clinical efficacy of compression therapy in preventing oxaliplatin-induced peripheral neuropathy: a prospective randomized controlled study.
Support Care Cancer 2025:33:527
Clinical Decision Support in the Electronic Medical Record for Symptom Management
Algorithm-based Decision Support for Symptom Self-management Among Adults with Cancer: Results of Usability Testing
BMC Medical Informatics and Decision Making 2018; 18:31
Feasibility of Using Algorithm-Based Clinical Decision Support for Symptom Assessment and Management in Lung Cancer
J Pain Symptom Manage. 2015 Jan;49(1):13-26
Using data-driven clinical decision support to integrate precision cancer symptom management into the electronic health record.
Sem Oncol Nurs 2025; 41: 15906 DOI https://doi.org/10.1016/j.soncn.2025.151937
Creating Computable Algorithms for Symptom Management in an Outpatient Thoracic Oncology Setting
J Pain Symptom Manage 2013;46:911-924
Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT
Journal of Pain and Symptom Management 2022; 63:572-580
Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth
Psychooncology. Psychooncology. 2017 26:1105-122017 26:1105-12
Delirium
Dexmedetomidine: A Novel Strategy for Patients with Intractable Pain, Opioid-induced Hyperalgesia, or Delirium at the End of Life
J Palliat Med 2020; 23:1515–1517
Proportional sedation for persistent agitated delirium in palliative care: a randomized clinical trial.
JAMA Oncol 2025 Jul 31:e252212. doi: 10.1001/jamaoncol.2025.2212. Online ahead of print.
Endocrine Therapies - Side Effects
Aerobic exercise and aromatase inhibitor-associated musculoskeletal symptoms: results of a randomized clinical trial.
Support Care Cancer 2025;33:244
Elinzanetant for vasomotor symptoms from endocrine therapy for breast cancer.
N Engl J Med 2025;393:753-763
Exercise
Aerobic exercise and aromatase inhibitor-associated musculoskeletal symptoms: results of a randomized clinical trial.
Support Care Cancer 2025;33:244
Structured Exercise after Adjuvant Chemotherapy for Colon Cancer.
N Engl J Med 2025;393:13-25; Editorial: Irwin ML. Extending cancer survival with exercise—time for oncology to act. N Engl J Med 2025;393:82-84
The effect of exercise on pain in people with cancer: a systematic review with meta-analysis.
Sports Medicine 2023;53:1737-1752
Preventive effects of progressive resistance training of different intensities on breast cancer-related lymphedema.
Support Care Cancer 2025;33:194
Fatigue
Management of fatigue in adult survivors of cancer: ASCO-Society for Integrative Oncology guideline update.
J Clin Oncol 2024;42:2456-2487
A circadian and app-based personalized lighting intervention for the reduction of cancer-related fatigue.
Cell Reports Medicine 6, 102001 March 18, 2025. https://doi.org/10.1016/j.xcrm.2025.102001
Management of fatigue in adult survivors of cancer: American Society of Clinical Oncology – Society for Integrative Oncology (ASCO-SIO) Guideline update clinical insights.
JCO Oncol Pract 2024;1575-1579
The following abstract summary applies to both above ASCO Guidelines:
During cancer treatment: exercise, CBT, mindfulness-based programs and tai chi or qigong are recommended; psychoeducation and ginseng may be recommended.
For survivors: CBT and mindfulness-based programs help patients with moderate to severe fatigue; exercise is also recommended. Yoga, acupressure and moxibustion may be recommended.
For patients at the end of life: CBT (if time and attention allow) and corticosteroids
NOT RECOMMENDED: L-carnitine, antidepressants, wakefulness agents, or standing psychostimulants. (Stone PC, Minton O, Richardson A, et al. Methylphenidate versus placebo for treating fatigue in patients with advanced cancer: randomized, double-blind, multicenter, placebo-controlled trial. J Clin Oncol 2024;42:2382-2392).
GI Issues
Efficacy of cannabinoids for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis.
Support Care Cancer 2025;33:193
Ponsegromab for the treatment of cancer cachexia.
N Eng J Med 2024; 391:2291-2303.
Comments from Dr. Abrahm:
GDF-15 has been identified as a mediator of cachexia in patients with lung, pancreatic and colorectal cancer. Inhibiting it with ponsegromab improved weight and acitivty and reduced symptoms of cachexia in a Phase 2 randomized, double-blind placebo-controlled trial. Fingers crossed!
Naldemedine for opioid-induced constipation in patients with cancer: a multicenter, double-blind, randomized, placebo-controlled trial.
J Clin Oncol 2024;42:4206-4217.
Antiemetics: ASCO Guideline Update
J Clin Oncol 2020; 38:2782-2797
Effective RX for CINV and MBO: Do we really need so many drugs?
MASCC/ISOO Expert Opinion on the Management of Oral Problems in Patients with Advanced Cancer
Support Care Cancer 2022; 30:8761-8773
Streptococcus salivarius K12 alleviates oral mucositis in patients undergoing radiotherapy for malignant head and neck tumors: a randomized controlled trial.
J Clin Oncol 2024;42. Online article.
Comments from Dr. Abrahm:
Patients can get SsK12 (streptococcus salivarius K12) lozenges from NOW foods, USA. During XRT, they took them tid and avoided any oral intake for at least an hour.
Symptom management for well-differentiated gastroenteropancreatic neuroendocrine tumors: ASCO guideline.
JCO Oncol Pract 2025; DOI https//doi.org/10.1200/OP-25-00133
Cancer cachexia: ASCO guideline rapid recommendation update.
The ASCO panel confirmed that there are NO FDA-approved medications to treat cancer cachexia, including olanzapine and mirtazapine.
Methylene blue for the treatment of intractable pain from oral mucositis related to cancer treatment: an uncontrolled cohort.
JNCCN 2021; 19:521-527.
Effect of adding electro-acupuncture to standard triple anti-emetic therapy on chemotherapy-induced nausea and vomiting: a randomized controlled clinical trial.
J Clin Oncol 2024;42:4051-4059.
Effective RX for CINV and MBO: Do We Really Need So Many Drugs?
February 2025
GI Disorders
Integrative Therapies
Methadone
Drug interactions of clinical importance among the opioids methadone and buprenorphine, and other frequently prescribed medications: A review.
2010. Am J Addict 19:4–16
Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper
J Pain Symptom Manage 2019; 57:635–645
A case of esophagogastric junction cancer treated with pain control by administering methadone tablets through a gastrostomy.
J Palliat Med 2024;27:1681-1684
Pain Management ASCO Guideline
Use of Opioids for Adults with Pain from Cancer or Cancer Treatment: ASCO Guideline
J Clin Oncol 2022; 41:914-930
What’s New in Palliative Care? ASCO 2025 Highlights
June 2025
Pain Management for Cancer Patients with Opioid Use Disorder
Consensus-based Guidance on Opioid Management in Individuals with Advanced Cancer-related Pain and Opioid Misuse or Use Disorder
JAMA Oncol. 2022;8:1107-1114
Pain Management - General
Trends in outpatient opioid prescriptions for cancer pain between 2016 and 2021.
JCO Oncol Pract 2025 DOI https://doi.org/10.1200/OP-24-00782
Beyond opioids: a multidisciplinary approach to cancer pain management.
(editorial re: Admane article) JCO Oncol Pract 2025 DOI https://doi.org/10.1200/OP-25-00258
Buprenorphine for Cancer pain- the safest opioid, and patients with cancer cannot get it.
JAMA Oncol 2025; E1 (Opinion)
Ketamine use for cancer and chronic pain management.
Front Pharmacol 2021;11:599721
Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NISCO guideline.
Support Care Cancer 2025;33:2432
Reassessing opioid conversion guidelines: narrow consensus and clinical challenges.
Support Care Cancer 2025;33:482 (editorial to Davis et al paper)
Treatment of intractable cancer pain with resiniferatoxin—an interim study.
NEJM Evid 2025;4(6). DOI: 10:1056/EVIDoa2400423
Buprenorphine for cancer pain: results from a systemic review.
J Opioid Manag 2024;20:B12
An examination of gastrointestinal absorption using the acetaminophen absorption test in critically ill patients with COVID-19: a retrospective cohort study.
Nutr Clin Pract 2021;36:853-862
What’s New in Supportive Oncology for Patients with Breast Cancer
October 2025
https://doi.org/10.6004/jnccn.2025.0032
Pain Management - Integrative Medicine
Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion).
Support Care Cancer 2024:32:229.
Comments from Dr. Abrahm:
If you’re wondering who to refer safely for acupuncture, this will be a helpful, comprehensive guideline.
Integration of self-hypnosis in an enhanced recovery after surgery program in gynecologic oncology: a prospective randomized trial.
Gynecol Oncol 2025;198:96-103
Non-Pharmacologic Therapies for Pain Management in Patients With Cancer: Opportunities and Challenges
Onc Live, May 2024
A digital therapeutic application (ePAL) to manage pain in patients with advanced cancer; a randomized controlled trial.
J Pain Symptom Manage 2024;68:261-271.
Music listening in stem cell transplantation and acute myeloid leukemia: a randomized clinical trial.
J Pain Symptom Manage 2024:67:501-511.
The effect of music therapy on anxiety, depression, pain and sleep quality of lung cancer patients: a systematic review and meta-analysis.
Support Care Cancer 2025;33:169
SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities.
JNCI Cancer Spectrum 2023;7:pkad042. https://doi.org/10.1093/jncics/pkad042
Effect of acupuncture for methadone reduction: a randomized clinical trial.
Ann Intern Med 2024;177:1039-1047.
Comments from Dr. Abrahm:
These were not cancer patients. They were patients 65 years of younger with opioid use disorder who had been using methadone maintenance treatment of at least 6 weeks.
Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline
J Clin Oncol 2022; 40:3998-4024
Efficacy of cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis
Support Care Cancer 2024;32:482
Palliative Sedation
Implementing Institutional Change: An Institutional Case Study of Palliative Sedation
Journal of Palliative Medicine 2005 8(3):666-76
Descriptive analysis of dexmedetomidine’s utility in a palliative care unit at the end of life.
J Palliat Med 2024;1303-1309
Dexmedetomidine in palliative care: a versatile new weapon against delirium and pain—systematic review.
J Palliat Med 2024;27:1390-1403
A systematic review of salivary gland hypofunction and/or xerostomia induced by non-surgical cancer therapies: prevention strategies.
Support Care Cancer 2025; 33:87
Psychedelic Assisted Therapy
Assessment of psilocybin therapy for patients with cancer and major depressive disorder.
JAMA Oncol 2023;9:864-866
Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-assisted Therapy in the Context of Serious Illness
J Palliat Med 2022; 25:1273-1281
Psilocybin in Palliative Care: An Update
Curr Geriatr Rep. 2023;12:50-59
Psychedelic-Assisted Therapy: What Insights It Can Offer Patients with Cancer
December 2025
Sexual Dysfunction
Sexual dysfunction in women with breast cancer: a systematic review.
Supportive Care in Cancer 2025;33:332
Skin Disorders
The role of dermocosmetics in the management of cancer-related skin toxicities: international expert consensus.
Support Care Cancer 2023;31:672.
Topical diclofenac for prevention of capecitabine-associated hand-foot syndrome: a double-blind randomized trial.
J Clin Oncol 2024;42:1821-1829.
Efficacy and safety of pregabalin and gabapentin for pruritus: a systematic review and meta-analysis.
J Pain Symptom Manage 2025;69:65-81. Note: Only abstract content is available).
Spinal Cord Compression
Spinal Cord Compression in Patients With Advanced Metastatic Cancer: “All I Care About is Walking and Living My Life.”
JAMA 2008;299:937-46
Assessment and Management of Patients With Metastatic Spinal Cord Compression: A Multidisciplinary Review
Journal of Clinical Oncology 2019 37: 61-71
Could you miss these clues? Deceptive presentations of Metastatic Spinal Cord Compression
April 2026
Virtual Reality
Application of virtual reality for supportive care in cancer patients: a systematic review.
Support Care Cancer 2024:32:570. Note: Only abstract content is available.
Virtual reality-based supportive care interventions for patients with cancer: an umbrella review of systematic reviews and meta-analyses.
Support Care Cancer 2024:32:603. Note: Only abstract content is available.
Virtual reality in palliative care: a systematic review
Healthcare 2022;10:1222.
Mind over Matter: How Hypnosis and Virtual Reality Can Help Patients with Cancer
November 2025
Miscellaneous
A Prospective Study of Prolonged Central Venous Access in Leukemia
JAMA. 1982;248:2868-73
Distressing Therapy-Induced Side Effects
The Oncology Nurse, November 2024
Top ten tips palliative care clinicians should know about the psychiatric manifestations of non-psychiatric serious illness and treatments.
J Palliat Med 2024;27:1657-1664
Comments from Dr. Abrahm:
Barriers to PC referral were found to include: misunderstanding that palliative care was designed only for patients not on active therapy; fear of sending the wrong message that the patient is dying when they are not; and burdening patients with more appointments. The strongest predictor of provider making a referral is the patient request for one!