479: Designing a co-planned, evidence- and theory-informed clinical pharmacy intervention for cancer pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Pharmacological treatments, Pain in Special Populations , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Cancer pain remains inadequately managed globally, particularly in low-resource settings where workforce constraints, fragmented care, and limited access to medicines persist. Poor pain control is associated with reduced quality of life, psychological distress, and suboptimal medication adherence. Although pharmacists are increasingly recognised as important members of multidisciplinary teams, their role in cancer pain management has not been systematically translated into a theory-informed and contextually relevant intervention. This study aimed to co-plan and co-deliver an evidence- and theory-informed clinical pharmacy intervention for cancer pain management in Nepal through a multi-phase programme of evidence synthesis, contextual assessment, and feasibility testing.

Methods: A sequential, multi-phase approach was undertaken. First, a systematic review and meta-analysis synthesized evidence on pharmacist involvement in cancer pain management. Second, a multi-centre cross-sectional study in Nepal examined pain characteristics, determinants of pain severity, barriers to pain management, and medication adherence among cancer patients. Findings from these phases informed the co-planning of a structured, patient-centred clinical pharmacy intervention integrated within multidisciplinary oncology care. Finally, the intervention was co-delivered and evaluated through a multicentre feasibility-pilot randomised controlled trial conducted in two oncology centres in Nepal.

Results: The systematic review (64 studies) demonstrated that pharmacist involvement significantly reduced pain intensity (SMD −0.35; 95% CI −0.55 to −0.16) and adverse drug reactions (OR 0.69; 95% CI 0.61–0.79), and improved quality of life (SMD 0.80; 95% CI 0.29–1.32). The cross-sectional study (n=408) reported a mean pain score of 4.31±2.69, with 53.5% experiencing moderate-to-severe pain and a strong inverse association between pain severity and quality of life (QoL) (p<0.001). In the feasibility-pilot trial (n=92), 93.4% completed follow-up, with significant improvements in QoL, anxiety, depression, and medication adherence (all p < 0.001).

Conclusions: This study demonstrates that a co-planned, evidence- and theory-informed clinical pharmacy intervention can be feasibly co-delivered within multidisciplinary cancer care in a low-resource setting. The intervention was acceptable to patients and associated with meaningful improvements in patient-reported outcomes. These findings provide a robust foundation for a definitive randomised controlled trial and support the integration of clinical pharmacists into multidisciplinary cancer pain management pathways in Nepal and similar low-resource settings, with potential to strengthen workforce capacity, optimise analgesic use, improve equity in cancer pain care, and inform scalable, contextually adaptable models of pharmacist-led pain management.

References: Craig, P., et al. (2008). Developing and evaluating complex interventions. BMJ, 337, a1655.
IASP. (2019). ICD-11 classification of chronic pain.
Shrestha, S., et al. (2022). Pharmacist involvement in cancer pain management: A systematic review and meta-analysis. J Pain, 23(7), 1123–1142.
Shrestha, S., et al. (2024). Comprehensive assessment of pain characteristics and quality of life in cancer patients. Qual Life Res, 33, 2755–2771.
Shrestha, S., et al. (2024). Clinical pharmacist interventions on cancer pain management (PharmaCAP). Support Care Cancer, 32, 828.
World Health Organization. (1986). Cancer pain relief.

Presenting Author: Sunil Shrestha
Submitting Author: Sunil Shrestha

Senior Author: Siew Hua Gan, Vibhu Paudyal and Shaun Lee

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Sunil Shrestha: BPharm, PharmD, PhD - Kathmandu Cancer Center
• Simit Sapkota: MBBS, MD - Kathmandu Cancer Center
• Siew Li Teoh: PhD - Monash University Malaysia
• Bhuvan KC: PhD - School of Clinical Sciences, Faculty of Health, Queensland University of Technology
• Shaun Lee: PhD - Monash University Malaysia
• Siew Hua Gan: PhD - University of Cyberjaya
• Vibhu Paudyal: PhD - King's College London