Rethinking Cancer Pain Through Oncology and Palliative Medicine Collaboration With Joseph McCollom, DO, and Jasmin Hundal, MD, MS, MPH

Journey into Oncology and Palliative Medicine

Dr. McCollom, who is dual-trained in both oncology and palliative medicine, explained that what drew him to the field was “the intersection between care against the disease and care for a patient,” noting that patients who are supported along the way tend to have the best outcomes. He emphasized that palliative training strengthens communication skills, observing that “a palliative care fellowship allows you to really focus on that art of the conversation for a year,” a skill invaluable across oncology practice.

Misconceptions About Cancer Pain

Cancer pain is often misunderstood, said Dr. McCollom. He pointed to Dame Cicely Saunders, a pioneer of the hospice movement, and her concept of “total pain.” He explained that “pain itself is not just a physical phenomenon caused by a tumor; it also integrates emotional, social, and spiritual suffering,” underscoring the need for a truly holistic and multidisciplinary approach. Without addressing these multiple dimensions, oncology professionals may inadvertently underestimate the complexity of their patients’ pain experiences.

Barriers to Adequate Pain Control

Despite advances in oncology, undertreated pain remains common. “Opioids have had a significant stigma despite being the cornerstone of cancer pain management,” said Dr. McCollom. He noted that hesitation may stem not only from patients but also from caregivers and even providers. “Some providers are simply less comfortable prescribing opioids now than a decade ago, and patients are left suffering as a result,” he observed. Beyond stigma, access remains a structural challenge: “There are very few specialists in pain and palliative oncology compared to the number of patients who need them.”

Impact of Early Palliative Integration

Strong evidence supports early integration of palliative care into oncology. Reflecting on studies in non–small cell lung cancer and gastrointestinal malignancies, Dr. McCollom noted, “If palliative care were a drug, the FDA would approve it based on the overall survival improvement of that study.” Early referral not only improves pain scores and quality of life but also helps caregivers, reduces healthcare costs, and, counterintuitively, extends survival. Updated American Society of Clinical Oncology (ASCO) guidelines now recommend referral to palliative care within eight weeks of a diagnosis of advanced or incurable cancer, a standard that Dr. McCollom described as “potentially dramatic for both patient and caregiver outcomes.”

Beyond Medications: Non-Pharmacologic Strategies

Managing cancer pain requires the integration of supportive approaches alongside medications. Dr. McCollom explained that “pain is an experiential trauma that goes back to all of your earliest memories of illness,” so emotional and social supports can be just as vital as pharmacology. Nurse navigators, social workers, and rehabilitation specialists are essential partners. He pointed out that “physical therapy programs can help patients gradually regain strength even when the cancer itself has altered their bodies,” offering profound relief. Similarly, integrative practices such as mindfulness, yoga, and tai chi can reframe the pain experience. He emphasized that these should not be considered alternatives to standard care, but evidence-backed complements.

Innovations and the Future of Pain Management

Digital tools are shaping the next generation of supportive oncology care. “Patient-reported outcome systems and AI tools are allowing us to capture symptoms in real time,” Dr. McCollom said. He described how AI-based platforms can interact with patients overnight, triage the severity of reported pain, and rapidly escalate concerning findings to nurses. “Especially in rural communities with limited resources, these tools can be revolutionary,” he noted, pointing to early programs that combine guideline-driven algorithms with patient support.

Closing Thoughts for Pain Awareness Month

In closing, Dr. McCollom encouraged oncologists to strengthen ties with palliative care colleagues. “If you want to increase your skills in cancer pain management, reach out to your local palliative care clinicians,” he said, stressing that both fields can “teach and learn from one another” to improve care.

Key Takeaways

• View pain holistically: Address physical, emotional, social, and spiritual components.
• Challenge stigma: Reinforce evidence-based use of opioids when appropriate.
• Refer early: Early palliative involvement improves quality of life and survival.
• Leverage non-pharmacologic tools: Rehabilitation and integrative practices are vital.
• Adopt innovations: Electronic patient-reported outcomes and AI triage platforms enhance real-time care.
• Collaborate widely: Oncology and palliative care together produce better patient experiences.

About the Speakers

Joseph McCollom, DO, is a Palliative Oncologist and a Gastrointestinal Medical Oncology Physician at Parkview Cancer Institute in Indiana. He specializes in the treatment of patients with gastrointestinal cancer and the use of cutting-edge treatments to improve outcomes. Dr. McCollom serves as the Medical Director of Palliative, Survivorship, and Integrative Oncology at Parkview, and is he is passionate about integrating palliative medicine throughout the cancer care journey.

Jasmin Hundal, MD, MS, MPH, is a second-year Hematology/Oncology Fellow at the Cleveland Clinic in Cleveland, Ohio. Previously, she completed her Internal Medicine Residency at the University of Connecticut. Dr. Hundal’s main area of interest is the overlap between cardiometabolic health and cancer, particularly for breast cancer patients and survivors. Outside of work, she enjoys traveling, cooking, and hiking.