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My name is Judith Paice,
I'm the Director of the Cancer Pain Program in
the Division of Hematology-Oncology at Northwestern University,
in the Feinberg School of Medicine, located in Chicago.
Today's topic is cancer pain.
We're going to talk about some trends in cancer pain, that have resulted
because of some fantastic advancements that we've been seeing in oncology treatment.
We're going to recognize the problems faced by
a cancer survivors who, more and more often, are experiencing persistent pain.
We're going to discuss evolving challenges as we manage pain associated with malignancies.
A brief history: starting in the early 1900s (not really that terribly long ago),
we had very few treatment options for people with cancer,
primarily surgery or some very rudimentary radiotherapy.
In the early 1940s, actually as a result of soldiers handling mustard gas,
some interesting observations were made in the reduction of the lymphatic tissues
seen in these soldiers, and clever scientists put that
together to identify that nitrogen mustard may be
an effective treatment for lymphomas.
This was indeed responsible for reducing the size of these lymphoma tumors,
however, the results were not sustained.
But that began the early phase of chemotherapy, and we saw an advance in the 50s with
the introduction of 5-fluorouracil, methotrexate, and
the beginning of hormonal therapy for breast and prostate cancers.
In the 60s, people began to dream about the potential for cure, and we achieved
that through cure of some of the liquid tumors, like leukemias and Hodgkin's disease.
In the 70s we saw the cure of the first solid tumors, and this was the testicular cancers.
Some really amazing advancements in a relatively short period of time.
Then we really hit the accelerator, and saw
the first introduction of monoclonal antibodies that were approved,
agents such as rituximab, trastuzumab, and our first tyrosine kinase inhibitors were approved.
In the 2000s, now we are seeing immune system modulators, checkpoint inhibitors,
and more recently, therapies called CAR T,
where we are modifying the patient's own immune system.
Those advancements have led to amazing survival rates.