Chemotherapy for the treatment of cancer pain

First, the cytostatic and hormonal therapy of cancer primarily affects the tumor mass and in this way also the cancer pain. If chemotherapy is effective, malignant organ infiltrations may be sufficiently treated. However, the pain resulting from malignant organ destruction cannot usually be influenced by chemotherapy alone. Second, paraneoplastic syndromes showing pain symptomatology (e.g., polyneuropathies, rheumatoid symptoms) may be affected positively in chemotherapy-sensitive tumors. Third, the alleviation of cancer pain by palliative chemotherapy must be purchased by the specific drug toxicity. Detailed trials comparing the advantages and disadvantages of cancer chemotherapy are still lacking. Fourth, the efficacy of cancer chemotherapy should not be evaluated by subjective improvement (reduction of cancer pain) alone, but by objective response criteria (remission rate, response duration, survival). Fifth, at present about 50% of all cancers can potentially be influenced by chemotherapy (10% curative, 40% palliative). And, sixth, besides oral and intravenous administration, local, intrathecal, intracavitary, and intra-arterial administration of cytostatic agents is also used in the palliative care of cancer pain.