Abstract
Background
Cancer pain remains a prevalent and debilitating symptom among patients with advanced malignancies, significantly compromising quality of life. While clinical guidelines for pain management exist, real-world challenges such as polypharmacy, poor adherence, and drug-related problems (DRPs) hinder effective treatment. Pharmacist-led Medication Therapy Management (MTM) offers a structured approach to address these challenges, but its role in cancer pain management remains underexplored.
Aim
This study aimed to evaluate the effect of pharmacist-led MTM on cancer pain management.
Methods
A pre-post interventional study was conducted using the MTM services implemented in January 2023.
Results
A total of 246 patients were included in the pre-MTM group (n = 100) and MTM (n = 146) groups. Pharmacist-led MTM was associated with better cancer pain score at 30-day follow-up (3.85 ± 1.07 VS 4.85 ± 1.47, P < 0.001) and greater reduction in pain scores (1.92 ± 0.84 VS 2.81 ± 1.21, P < 0.001) compared to the pre-MTM group. In Additional, the MTM effectively identified and resolved the DRPs, achieving a resolution rate of 73.81%. A lower incidence of adverse drug reactions, including constipation, nausea, and vomiting, was observed in the MTM group (P < 0.05). Furthermore, pharmacist-led MTM was associated with a higher proportion of patients with high medication adherence, with 67.81% in the MTM group compared with 45% in the pre-MTM group (P < 0.001). Pharmacist-led MTM was associated with higher patient satisfaction with treatment (4.71 ± 1.14 vs. 3.04 ± 2.07, P < 0.001) and follow-up (3.92 ± 1.76 vs. 3.46 ± 1.70, P = 0.02) compared with the pre-MTM group.
Conclusion
Pharmacist-led MTM plays a crucial role in optimizing cancer pain management by reducing DRPs, improving adherence, minimizing adverse drug reactions, and enhancing patient satisfaction. It is an essential component of comprehensive, individualized care that ultimately improves the clinical outcomes and quality of life of patients with cancer.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40780-026-00544-8.
Keywords: Cancer pain management; Medication therapy management (MTM); Drug-related problems (DRPs); Pharmacist intervention, Numerical rating scale (NRS)
Introduction
Cancer pain is a prevalent and distressing symptom among patients with advanced malignancies, affecting 70–90% of patients with at some stage of their illness [1, 2]. Inadequately managed pain significantly compromises physical, psychological, and social well-being [3]. Although various clinical guidelines emphasize standardized pain treatment, disparities persist in real-world practice due to polypharmacy, comorbidities, and suboptimal adherence to therapeutic regimens.
Pharmacists are integral members of multidisciplinary healthcare teams and play a vital role in promoting rational drug use. In recent years, multiple studies have explored the impact of pharmacist interventions on cancer pain management. For instance, Shrestha et al. [4] demonstrated the feasibility and preliminary effectiveness of integrating clinical pharmacists into cancer pain management teams in Nepal. Liu et al. [5] and Zhang et al. [6] reported that pharmacist involvement was effective in resolving drug-related problems (DRPs) and reducing medication costs. Zheng et al. [7] further showed that pharmacist-led opioid management programs improved medication adherence and patient-reported outcomes such as quality of life. However, these studies varied widely in their intervention strategies and outcome indicators.
To address these challenges, pharmacist-led Medication Therapy Management (MTM) offers a structured and standardized model of pharmaceutical care. MTM encompasses a range of professional services provided by pharmacists with expertise in pharmacology, including patient education, medication counseling, and adherence support. These services aim to enhance treatment efficacy by improving medication adherence, preventing medication errors, and empowering patients in self-medication management [8–10]. MTM has been widely implemented in chronic disease management, such as diabetes [11] and hypertension [8]. However, limited data specifically evaluates the impact of MTM as a standardized service in the context of cancer pain management.
This study aimed to evaluate the application of Pharmacist-led MTM in patients with cancer pain to ensure comprehensive pharmaceutical care throughout treatment. This study assessed key clinical outcomes, including pain relief rates, incidence of adverse drug reactions, and medication adherence.
Materials and methods
Ethical approval
The study protocol was approved by the Ethics Review Committee of the People’s Hospital of Kaihua on September 23, 2022 (Approval No.: 2022-03) and strictly adhered to the ethical guidelines of the Declaration of Helsinki.
Inclusion and exclusion criteria
Patients were eligible for inclusion if they met the following criteria: (1) age ≥ 18 years, (2) pathologically or cytologically confirmed advanced malignant tumors, (3) receiving opioid analgesic therapy, (4) expected survival time ≥ 1 month, and (5) conscious and able to cooperate with questionnaire surveys.
Patients were excluded if they met any of the following criteria: (1) no cancer pain, and (2) impaired consciousness or mental disorders preventing effective communication.
Data sources
This study included patients with cancer pain admitted to our hospital between January 2022 and December 2024. Pharmacist-led MTM services are expected to be introduced in January 2023. Patients admitted between January 2022 and December 2022 were assigned to the pre-MTM group, where those admitted between January 2023 and December 2024 were assigned to the MTM group. All procedures in this study were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the 1975 Helsinki Declaration (revised in 2000).
The Ethics Committee of Kaihua People’s Hospital approved the use of patient data, materials, and/or test results for research purposes (2022-03).
Intervention measures
Pre-MTM Group: Patients received standard treatment provided by clinical physicians and nursing staff following the 2018 Cancer Pain Treatment Guidelines [12].
MTM Group: In addition to standard treatment, pain clinical pharmacists provided MTM services and pharmaceutical interventions.
MTM services and pharmaceutical interventions
MTM services
Clinical pharmacists assessed patients with cancer pain following the principles of standardized, quantitative, comprehensive, and dynamic evaluation, as outlined in the 2018 Cancer Pain Treatment Guideline [12]. A personalized medication plan was developed in collaboration with clinicians, based on each patient’s condition and pain status. At discharge, the patient received comprehensive medication counseling. Pharmacists conduct weekly follow-ups via phone or in person for 30 days post-discharge to assess: (1) pain levels; (2) adverse drug reactions; (3) acute pain episodes; (4) medication use and adherence. Medication plans were adjusted as needed in consultation with physicians.
Pharmaceutical interventions
During hospitalization, the pharmaceutical care network europe (PCNE) classification system (version 9.0) was used to identify and address the DRPs in the MTM group. The classification system includes five key components: (1) problem (P): number and type of identified DRPs; (2) cause (C): underlying causes of DRPs; (3) planned interventions (I): types of interventions implemented; (4) intervention acceptance (A): acceptance rate of pharmacist interventions; and (5) outcome (O): effectiveness of the interventions.
Each component was analyzed in detail, and interventions were categorized into three levels: (1) patient level: providing medication education, drug counseling, and adherence monitoring to enhance self-management; and (2) physician level, collaborating with physicians on drug selection and optimizing medication therapy to resolve actual or potential DRPs. (3) Medication level: Adjusting the dosage, administration schedules, and other drug-related parameters to improve efficacy and safety.
Observational indicators
DRPs
The PCNE classification system was used to analyze the types, causes, intervention measures, and outcomes of DRPs in the MTM group during hospitalization.
Pain assessment
Pain was assessed in both groups using the following: (1) numerical rating scale (NRS) scores at the first and 30-day follow-up, and (2) incidence of breakthrough pain episodes (mean number of breakthrough pain episodes during the 30-day follow-up period).
Incidence of adverse reactions
The incidence rates of constipation, nausea, vomiting, and other adverse reactions were recorded at the first visit and 30-day follow-up in both groups.
Adherence
Medication adherence in both groups was assessed on the second visit using the Chinese version of the Morisky Medication Adherence Scale (MMAS-8). Permission to apply for the MMAS-8 score was obtained. The total score was eight, with scores classified as follows: (1) low adherence (< 6), (2) moderate adherence (6–7), and (3) high adherence (7–8).
A hospital-made treatment satisfaction survey (Table S1) and follow-up satisfaction survey (Table S2) were conducted. Each satisfaction questionnaire consisted of six items, each rated on a 3-point Likert scale (0 = dissatisfied, 0.5 = neutral, 1 = satisfied), yielding a total score ranging from 0 to 6, with higher scores indicating greater satisfaction.
Statistical analysis
Statistical analyses were performed using SPSS version 24.0. Continuous data were expressed as mean ± standard deviation (x̄ ± s) and analyzed using the t-test. Categorical data are expressed as percentages (%) and were analyzed using the χ² test. Statistical significance was set at P < 0.05.
Results
General information of patients
In total, 246 patients met the inclusion criteria, with 100 in the pre-MTM group and 146 in the MTM groups. The baseline characteristics of the two groups are presented in Table 1. There were no statistically significant differences between the two groups in terms of age, sex, marital status, race, BMI, diagnosis, cancer stage, or health insurance coverage (P > 0.05). The mean baseline opioid dosage, expressed as oral morphine equivalents, did not differ significantly between the pre-MTM group and the MTM group (47.92 ± 39.32 mg/day vs. 47.05 ± 34.62 mg/day, P = 0.422). Regarding pain type distribution, no statistically significant differences were observed between the groups (P = 0.662). In the pre-MTM group, 52% of patients had somatic pain, 24% had visceral pain, and 24% had neuropathic pain, compared with 55.5% (81/146), 19.2% (28/146), and 25.3% (37/146), respectively, in the MTM group. The hospitalization duration was comparable between the two groups (pre-MTM: 7.20 ± 8.15 days; MTM: 7.27 ± 7.01 days; P = 0.470; Table 1).
Table 1.
Socio-demographic characteristics of cancer pain patients (n = 246)
| pre-MTM group (n = 100) |
MTM group (n = 146) |
P value | ||
|---|---|---|---|---|
| Age | 67.98 ± 10.09 | 67.67 ± 11.04 | 0.412 | |
| Gender | ||||
| Male | 67 | 100 | 0.805 | |
| Female | 33 | 46 | ||
| Marital status | ||||
| Married | 76 | 116 | 0.521 | |
| Single/Divorced/Unknown | 24 | 30 | ||
| Race | ||||
| Han | 98 | 142 | 0.712 | |
| other | 2 | 4 | ||
| BMI | 21.96 ± 2.86 | 21.50 ± 3.38 | 0.144 | |
| Diagnosis | 0.865 | |||
| lung cancer | 34 | 49 | ||
| liver cancer | 18 | 24 | ||
| colorectal cancer | 12 | 15 | ||
| gastric cancer | 5 | 14 | ||
| esophagus cancer | 7 | 10 | ||
| other | 24 | 34 | ||
| Cancer stage | ||||
| III | 32 | 47 | 0.998 | |
| IV | 64 | 93 | ||
| Unknown | 4 | 6 | ||
| Health ensurance coverage | 0.824 | |||
| Yes | 86 | 127 | ||
| No | 14 | 19 | ||
| Baseline opioid dosage (mg oral morphine/day) | 0.422 | |||
| 47.92 ± 39.32 | 47.05 ± 34.62 | |||
| Pain type | 0.662 | |||
| Somatic pain | 52 | 81 | ||
| Visceral pain | 24 | 28 | ||
| Neuropathic pain | 24 | 37 | ||
| Hospital duration | 7.20 ± 8.15 | 7.27 ± 7.01 | 0.470 | |
Control rate of cancer pain
The impact of pharmacist-led MTM on the control rate of cancer pain is shown in Table 2. At baseline, there was no significant difference in the initial cancer pain scores between the pre-MTM group (6.81 ± 1.85) and MTM group (6.66 ± 1.89) (P = 0.266) as shown in Table 2. At the 30-day follow-up, the pain score in the MTM group had decreased by 2.81 ± 1.21 points, which was significantly greater than the reduction in the pre-MTM group (1.92 ± 0.84 points, P < 0.001). The pain score at the 30-day follow-up in the MTM group (3.85 ± 1.07) was significantly lower than that in the pre-MTM group (4.85 ± 1.47; P < 0.001). During the 30-day follow-up, the MTM group had a significantly lower mean number of breakthrough pain episodes than the pre-MTM group (1.75 ± 1.26 vs. 2.65 ± 1.26, P < 0.001). During the 30-day follow-up, the MTM group was associated with lower pain scores and fewer breakthrough pain episodes compared with the pre-MTM group.
Table 2.
Control rate of cancer pain
| pre-MTM group (n = 100) |
MTM group (n = 146) |
P value | |
|---|---|---|---|
| cancer pain score at first visit | 6.81 ± 1.85 | 6.66 ± 1.89 | 0.266 |
| cancer pain score at 30-day follow-up | 4.85 ± 1.47 | 3.85 ± 1.07 | P < 0.001 |
| changes in cancer pain score | 1.92 ± 0.84 | 2.81 ± 1.21 | P < 0.001 |
| incidence of breakthrough pain* | 2.65 ± 1.26 | 1.75 ± 1.26 | P < 0.001 |
*mean number of breakthrough pain episodes during the 30-day follow-up period
DRPs and resolution in the MTM group
The impact of pharmacist-led MTM on DRP and resolution is shown in Table 3. Among the 146 patients in the MTM group, 84 DRPs were identified, with an average of 0.58 DRPs per patient. A total of three primary problem domains (P1–P3) were identified in the MTM group according to the PCNE DRP classification tool (Table 3). Most DRPs were related to “treatment safety” (P2, 40.48%) and “treatment effectiveness” (P1, 38.09%), followed by a smaller proportion classified as “other problems” (P3, 21.43%). Within the domain of “treatment effectiveness” (P1), the most frequent issues were “suboptimal treatment effect” (P1.2, 21.43%), “untreated symptoms or indications” (P1.3, 7.14%), and “no effect of drug treatment” (P1.1, 5.95%). All P1-category problems were successfully resolved (100%). For “treatment safety” (P2), the predominant problem was “adverse drug events possibly occurring” (P2.1), accounting for 36.90% of all DRPs; however, only 48.39% of these were fully resolved. “Toxic effects suspected” (P2.2) accounted for 3.57%, all of which were resolved. No cases were recorded for P2.3 or P2.4. Within the “other” (P3) domain, “patient dissatisfaction with therapy” (P3.2) constituted 21.43% of all DRPs, with a resolution rate of 66.67%.
Table 3.
Identified problems and resolved problem in the MTM group according to the PCNEa DRPb classification tool
| Primary Domain | Problem | Cases found | % | Cases solved | % |
|---|---|---|---|---|---|
| P1 Treatment effectiveness | P1.1 No effect of drug treatment | 5 | 5.95 | 5 | 100.00 |
| P1.2 Effect of drug treatment not optimal | 18 | 21.43 | 18 | 100.00 | |
| P1.3 Untreated symptoms or indication | 6 | 7.14 | 6 | 100.00 | |
| P1.4 Wrong effect of drug administered | 3 | 3.57 | 3 | 100.00 | |
| P2 Treatment safety | P2.1 Adverse drug event (possibly) occurring | 31 | 36.90 | 15 | 48.39 |
| P2.2 Toxic effect suspected | 3 | 3.57 | 3 | 100.00 | |
| P2.3 Side effect suffered | 0 | 0.00 | 0 | / | |
| P2.4 Contraindicated drug prescribed | 0 | 0.00 | 0 | / | |
| P3 Other | P3.1 Problem with cost-effectiveness | 0 | 0.00 | 0 | / |
| P3.2 Patient dissatisfied with therapy | 18 | 21.43 | 12 | 66.67 | |
| P3.3 Unclear problem / miscellaneous | 0 | 0.00 | 0 | / |
a Pharmaceutical Care Network Europe, b drug-related problem
As shown in Table 4, based on the PCNE DRP classification, the most frequent causes of DRPs in the MTM group were associated with dose selection (C3, 27.98%), particularly drug dose too low (C3.1, 15.48%) and drug dose too high (C3.2, 7.14%). This was followed by drug use process issues (C6, 23.81%), including inappropriate timing of administration, under-administration, over-administration, and drugs not administered at all. Patient-related factors (C7, 21.43%) were also common, with patients taking less medication than prescribed or not taking it at all (C7.1, 19.05%) as the leading cause. Additional causes were identified within drug selection (C1, 16.67%) and drug form (C2, 5.95%), whereas no causes were found in the dispensing (C5), patient transfer (C8), or other categories (C9).
Table 4.
Identified causes in the intervention group based on the PCNE a DRP b classification tool
| Primary Domain | Cause | Cases | % |
|---|---|---|---|
| C1 Drug selection | C1.1 Inappropriate drug according to guidelines/formulary | 6 | 7.14 |
| C1.2 Inappropriate drug (within guidelines but otherwise contra-indicated) | 5 | 5.95 | |
| C1.3 No indication for drug | 3 | 3.57 | |
| C1.4 Inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements | 0 | 0.00 | |
| C1.5 Inappropriate duplication of therapeutic group or active ingredient | 0 | 0.00 | |
| C1.6 No or incomplete drug treatment in spite of existing indication | 0 | 0.00 | |
| C1.7 Too many drugs prescribed for indication | 0 | 0.00 | |
| C2 Drug form | C2.1 Inappropriate drug form (for this patient) | 3 | 3.57 |
| C2.2 Inappropriate dose form | 2 | 2.38 | |
| C3 Dose selection | C3.1 Drug dose too low | 13 | 15.48 |
| C3.2 Drug dose too high | 6 | 7.14 | |
| C3.3 Dosage regimen not frequent enough | 1 | 1.19 | |
| C3.4 Dosage regimen too frequent | 1 | 1.19 | |
| C3.5 Dose timing instructions wrong, unclear or missing | 0 | 0.00 | |
| C4 Treatment duration | C4.1 Duration of treatment too short | 6 | 7.14 |
| C4.2 Drug dose too high | 2 | 2.38 | |
| C5 Dispensing | C5.1 Prescribed drug not available | 0 | 0.00 |
| C5.2 Necessary information not provided | 0 | 0.00 | |
| C5.3 Wrong drug, strength or dosage advised (OTC) | 0 | 0.00 | |
| C5.4 Wrong drug or strength dispensed | 0 | 0.00 | |
| C6 Drug use process | C6.1 Inappropriate timing of administration or dosing intervals | 6 | 7.14 |
| C6.2 Drug under-administered | 4 | 4.76 | |
| C6.3 Drug over-administered | 4 | 4.76 | |
| C6.4 Drug not administered at all | 4 | 4.76 | |
| C6.5 Wrong drug administered | 0 | 0.00 | |
| C6.6 Drug administered via wrong route | 0 | 0.00 | |
| C7 Patient related | C7.1 Patient uses/takes less drug than prescribed or does not take the drug at all | 16 | 19.05 |
| C7.2 Patient uses/takes more drug than prescribed | 2 | 2.38 | |
| C7.3 Patient abuses drug (unregulated overuse) | 0 | 0.00 | |
| C7.4 Patient uses unnecessary drugs | 0 | 0.00 | |
| C7.5 Patient takes food that interacts | 0 | 0.00 | |
| C7.6 Patient stores drugs inappropriately | 0 | 0.00 | |
| C7.7 Inappropriate timing or dosing intervals | 0 | 0.00 | |
| C7.8 Patient administers/uses the drug in a wrong way | 0 | 0.00 | |
| C7.9 Patient unable to use drug/form as directed | 0 | 0.00 | |
| C7.10 Inappropriate drug/therapeutic monitoring (incl. TDM) | 0 | 0.00 | |
| C8 Patient transfer related | C8.1 Incomplete or incorrect transfer of medication information | 0 | 0.00 |
| C8.2 Incomplete or incorrect transfer of patient information | 0 | 0.00 | |
| C8.3 No obvious cause | 0 | 0.00 | |
| C9 Other | C9.1 Other cause; specify | 0 | 0.00 |
| C9.2 No obvious cause | 0 | 0.00 |
Occurrence of adverse reactions
The impact of pharmacist-led MTM on the occurrence of adverse reaction in 30-day follow-up is shown in Table 5. In the pre-MTM group, constipation occurred in 30 patients (30.0%), nausea in 34 (34.00%), vomiting in 12 (12.00%), and other adverse reactions in 5 (5.00%). In the MTM group, constipation occurred in 23 patients (15.75%), nausea in 33 (22.60%), vomiting in 6 (4.11%), and other adverse reactions in 3 (2.05%). The incidence of constipation, nausea, and vomiting were significantly lower in the MTM group than in the pre-MTM group (P < 0.05). During the 30-day follow-up, pharmacist-led MTM was associated with lower incidences of drug reactions, such as constipation, nausea, and vomiting compared with the pre-MTM group.
Table 5.
Incidence of adverse reactions
| pre-MTM group n (%) |
MTM group n (%) |
P value | |
|---|---|---|---|
| Constipation | 30(30.0%) | 23(15.8%) | 0.008 |
| Nausea | 34(34.0%) | 33(22.6%) | 0.049 |
| Vomiting | 12(12.0%) | 6(4.1%) | 0.020 |
| Other | 5(5.0%) | 3(2.1%) | 0.201 |
Medication adherence
The interval to the second outpatient visit showed no significant difference (pre-MTM: 14.33 ± 8.70 days; MTM: 15.59 ± 7.31 days; P = 0.111). These findings indicate that differences in follow-up timing were minimal and unlikely to influence the assessment of medication adherence. The impact of pharmacist-led MTM on medication adherence is shown in Table 6. Medication adherence in patients with cancer pain was assessed. In the pre-MTM group, 19.00%, 36.00%, and 45.00% were Adherence-low, Adherence-moderate, and Adherence-high, respectively. In the MTM group, 4.11%, 28.08%, and 67.81% in the Adherence-Low, Adherence-Moderate, and Adherence-High groups, respectively. Compared to the pre-MTM group, the proportion of adherence-high patients in the MTM group significantly increased, while the proportion of adherence-low patients also decreased. Pharmacist-led MTM was associated with a higher proportion of patients with high medication adherence and a lower proportion of patients with low adherence compared with the pre-MTM group.
Table 6.
Adherence of cancer pain patients to treatment (n = 246)
| Pre-MTM group | MTM group | P value | |
|---|---|---|---|
| n (%) | n (%) | ||
| Adherence-Low | 19(19.0%) | 6(4.1%) | P < 0.001 |
| Adherence-Moderate | 36(36.0%) | 41(28.1%) | |
| Adherence-High | 45(45.0%) | 99(67.8%) |
Satisfaction of treatment and follow-up
The association between pharmacist-led MTM and patient satisfaction with treatment and follow-up is shown in Table 7. Satisfaction with treatment and follow-up in the MTM group was 4.71 ± 1.14 and 3.92 ± 1.76, respectively, which was higher than that observed in the pre-MTM group (satisfaction with treatment: 3.04 ± 2.07, P < 0.001; satisfaction with follow-up: 3.46 ± 1.70, P = 0.02).
Table 7.
Satisfaction of treatment and follow-up
| Pre-MTM group (n = 100) |
MTM group (n = 146) |
P value | |
|---|---|---|---|
| satisfaction of treatment | 3.04 ± 2.07 | 4.71 ± 1.14 | P < 0.001 |
| satisfaction of follow-up | 3.46 ± 1.70 | 3.92 ± 1.76 | P = 0.02 |
Discussion
Cancer pain is a common and debilitating symptom that significantly impairs patients’ quality of life and overall well-being [13–15]. Given the complexity of cancer pain regimens, including opioid therapy, polypharmacy, and adverse drug reactions (ADRs) risk, comprehensive and individualized management is essential for optimizing outcomes [14, 16]. This study provides real-world evidence that pharmacist-led MTM is associated with favorable outcomes in the management of cancer pain. By implementing a structured pharmaceutical care model, MTM was associated with favorable outcomes across multiple clinical domains, including better pain control, higher medication adherence, fewer DRPs, and a lower incidence of ADRs.
The findings of this study underscore the significance of pharmacists’ involvement in cancer pain management. Unlike general pharmacist interventions, which often involve isolated or reactive responses to specific issues [5–7, 17], MTM represents a formalized and systematic approach to pharmaceutical care [8, 11]. In our study, pharmacist-led MTM was associated with better pain control (Table 2), fewer DRPs (Table 3), lower incidence of ADRs (Table 5), better adherence (Table 6) and patient satisfaction (Table 7). It seemed that pharmacist-led MTM has more consistent outcomes compared to fragmented or ad hoc pharmacist interventions reported in previous studies [6, 15, 18, 19].
During the 30-day follow-up, the MTM group was associated with lower pain scores and fewer breakthrough pain episodes compared with the pre-MTM group (Table 2). Importantly, patients in the MTM group also experienced a greater reduction in pain scores from baseline, suggesting improved dynamic pain control rather than merely lower absolute scores at follow-up. These findings are consistent with previous studies indicating that pharmacist involvement facilitates more individualized pain assessment and opioid titration, ultimately contributing to better symptom control [7, 20, 21]. The regular monitoring and follow-up inherent in MTM likely contributed to more timely adjustments in analgesic regimens, aligning with best practices for dynamic cancer pain management.
Pharmacist-led MTM was associated with favorable outcomes in the identification and resolution of DRPs. In this study, 146 patients in the MTM group, 84 DRPs were identified, and over 73% were successfully resolved. This intervention success rate is consistent with prior research from Liu et al. [5] and Zhang et al. [6], who also highlighted the pharmacist’s ability to identify medication-related issues early and to intervene effectively. In our study, the resolution rates for adverse reactions and patient dissatisfaction with therapy were lower compared to other DRP categories (Table 3). ADR-related DRPs had lower resolution rates because many opioid-related ADRs (e.g., constipation, nausea) are intrinsic to opioid therapy and may not be fully reversible despite optimization. This relatively lower resolution rate of patient dissatisfaction with therapy may be attributed to the multifactorial nature of patient dissatisfaction, which is often influenced by patients’ expectations, beliefs, prior treatment experiences, and psychological factors [22, 23]. Unlike medication-related or safety-related DRPs, dissatisfaction with therapy typically requires sustained communication, trust-building, and behavioral reinforcement over time, and therefore may not be fully resolved during a single hospitalization or short-term follow-up period [24, 25].
Medication adherence was higher in the MTM group, with a greater proportion of patients achieving high adherence compared with the pre-MTM group. These findings are in line with previous evidence indicating that pharmacist-led interventions may play an important role in supporting medication adherence among cancer patients [18].
Pharmacists in the MTM model likely contributed through reinforcement of medication instructions, addressing misconceptions about opioids, and enhancing patient empowerment [17].
Additionally, the MTM group had lower incidence of ADRs such as constipation, nausea, and vomiting. This observation is consistent with previous studies suggesting that pharmacist involvement may facilitate earlier identification and improved management of ADRs, which may contribute to a lower reported incidence [6, 18].
Pharmacist-led MTM was associated with higher patient satisfaction with treatment and follow-up (Table 7). This high level of satisfaction reflects the positive impact of MTM on both physical and psychological aspects of cancer pain management. Satisfaction is an important patient-reported outcome that correlates not only with trust and communication but also with adherence and clinical response [4, 20].
This study has several limitations that should be acknowledged. First, the pre–post observational design without randomization may introduce unmeasured confounding, thereby limiting the strength of causal inference regarding the intervention’s effectiveness. Second, baseline medication adherence was not assessed in the pre-MTM group, preventing a difference-in-differences analysis and restricting the interpretation of adherence-related outcomes. Third, DRPs were systematically documented only in the MTM group; thus, direct comparison of DRPs between groups was not possible. Fourth, several outcome measures—including satisfaction and adherence—relied on patient self-report, which may be subject to recall or reporting bias. Finally, this was a single-center study conducted in a tertiary hospital, which may limit the generalizability of the findings to other clinical settings. Future multicenter, randomized controlled studies are warranted to confirm these results and strengthen the evidence base for pharmacist-led MTM in cancer pain management.
In conclusion, the results of this study demonstrated that pharmacist-led MTM is associated with favorable outcomes in cancer pain management. MTM may play an important role in optimizing cancer pain management by addressing DRPs, enhancing medication adherence, reducing ADRs, and improving patient satisfaction. Our study underscores the value of formalized MTM services in delivering consistent, comprehensive pharmaceutical care. These results support broader implementation of MTM in oncology settings and provide a basis for future multicenter or long-term studies to validate and extend our findings.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Supplementary Table S1: Pain Treatment Satisfaction Questionnaire
Supplementary Table S2: Cancer Pain Treatment Follow-up Satisfaction Questionnaire
Acknowledgements
The authors extend their sincere gratitude to all team members for their contributions to this study. We are particularly grateful to Ms. Yufeng Liu for conducting regular telephone follow-ups with the patients and for systematically organizing the research data. Special thanks to Mr. Shunfu Zheng for performing precise dose adjustment protocols in cancer pain titration consultations. We acknowledge Ms. Li Feng for her rigorous on-site collection and documentation of clinical records. Our gratitude also extends to Professor Guoxiang Ye for integrating medical humanistic care into surgical treatments, significantly enhancing the patient experience. We appreciate their professional dedication and invaluable support throughout this study.
Abbreviations
- MTM
Medication therapy management
- DRPs
Drug-related problems
- PCNE
Pharmaceutical care network Europe
- MMAS-8
Morisky Medication Adherence Scale
Author contributions
Yu Dong and Yufeng Liu conceptualized the manuscript. Yu Dong: Led the writing for the manuscript and completed the analyses and created the tables. Yufeng Liu: Conducted regular telephone follow-ups with patients; systematically organized and validated the research data.Shunfu Zheng: Developed and implemented precise dose-adjustment protocols for cancer pain titration consultations.Li Feng: Performed rigorous on-site collection and documentation of clinical records.All authors reviewed the manuscript.
Funding
This work was supported by the Zhejiang Provincial Medical and Health Science and Technology Project (Grant No. 2023XY083).
Data availability
The data that support the findings of this study are available from the corresponding author, Dong Yu, upon reasonable request.
Declarations
Ethics approval
The study was approved by the Ethics Committee of People’s Hospital of Kaihua (Approval number: IRB-2022-03).
Consent to participate
Informed consent to participate in the study was obtained from all individual participants included in the study.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yu Dong and Yufeng Liu contributed to the work equally and should be regarded as co-first authors.
References
- 1.Ragusa C, Pereira B, Balayssac D. Assessment of pain prevalence in cancer patients undergoing anticancer treatments and in cancer survivors after completion of anticancer treatments: A French nationwide cross-sectional study. Int J Cancer 2024. [DOI] [PubMed]
- 2.Rau KM, Chen JS, Wu HB, Lin SF, Huang ML, Tai CJ, Hwang WL, Lu YC, Wang CC, Kuen Hsieh R. Cancer-related pain: a nationwide survey of patients’ treatment modification and satisfaction in Taiwan. Jpn J Clin Oncol. 2017;47(11):1060–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Schindler E, Richling I, Rose O. Pharmaceutical care network Europe (PCNE) drug-related problem classification version 9.00: German translation and validation. Int J Clin Pharm. 2021;43(3):726–30. [DOI] [PubMed] [Google Scholar]
- 4.Shrestha S, Sapkota S, Teoh SL, Kc B, Paudyal V, Lee SWH, Gan SH. Clinical pharmacist interventions on pain management in cancer patients (PharmaCAP) in low resource settings: a multicenter feasibility-pilot randomized controlled trial. Supportive Care Cancer: Official J Multinational Association Supportive Care Cancer. 2024;32(12):828. [DOI] [PubMed] [Google Scholar]
- 5.Liu J, Wang C, Chen X, Luo J, Xie J, Li S, Hu J, Shi C. Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center. J Am Pharmacists Association: JAPhA. 2020;60(1):76–80. [DOI] [PubMed] [Google Scholar]
- 6.Zhang P, Lv D, Zhao J, Sun S, Li L, Liao Y. Evaluation of pharmacists’ interventions on drug-related problems and drug costs in patients with cancer pain. Int J Clin Pharm. 2021;43(5):1274–82. [DOI] [PubMed] [Google Scholar]
- 7.Zheng X, Ding H, Xu S, Xie R, Liu Y, Zhai Q, Fang L, Tong Y, Sun J, Xin W, et al. Pharmacist-Led management improves treatment adherence and quality of life in Opioid-Tolerant patients with cancer pain: A randomized controlled trial. Pain Therapy. 2022;11(1):241–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Bulo B, Woldu M, Beyene A, Mekonnen D, Engidawork E. The impact of a medication therapy management service on the outcomes of hypertension treatment Follow-Up care in an Ethiopian tertiary hospital: A Pre-Post interventional study. Clin Med Insights Cardiol. 2024;18:11795468241274720. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Mohammadnezhad G, Ehdaivand S, Sebty M, Azadmehr B, Ziaie S, Esmaily H. Chronic kidney disease and adherence improvement program by clinical pharmacist-provided medication therapy management; a quasi-experimental assessment of patients’ self-care perception and practice. BMC Nephrol. 2024;25(1):463. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Sirimalla S, Mateti UV, Shenoy P, Shastry CS, Shetty S. Impact of medication therapy management on medication adherence and health-related quality of life among non-dialysis chronic kidney disease patients. Res Social Administrative Pharmacy: RSAP. 2025;21(12):1090–5. [DOI] [PubMed] [Google Scholar]
- 11.Joshi M, Pham C, Deng H, Mathew S, Norton RM, Kim K, Touchette DR, Tilton JJ. Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes. J Am Pharmacists Association: JAPhA. 2025;65(1):102253. [DOI] [PubMed] [Google Scholar]
- 12.Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, Ripamonti CI. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. (1569–8041 (Electronic)). [DOI] [PubMed]
- 13.Belitzky E, Ravani Carvalho LV, Taylor M, Ortiz CN, Baum L, Fiellin DA, Lustberg MB. Psychedelics for cancer pain and associated psychological distress: A narrative review of a potential strategy. Cancer Med. 2025;14(5):e70586. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Henriksen E, Young J, Power C, Chan C. What is cancer pain? Investigating attitudes of patients, carers, and health professionals: A cross-sectional survey. Pain Practice: Official J World Inst Pain. 2025;25(3):e70018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Liu Y, Chen T, Li X, Song J, Zhang F. Pharmacists’ knowledge, attitudes, and perceived barriers to cancer pain management: a cross-sectional survey in Chongqing, China. BMC Health Serv Res. 2025;25(1):210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Luo W, Huang H, Zhou Y, Min J, Wang C. Implementation of pharmaceutical strategies using the PDCA cycle for standardized management of cancer pain medications. Supportive Care Cancer: Official J Multinational Association Supportive Care Cancer. 2025;33(3):163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Shrestha S, Sapkota S, Paudyal V, Moon Z, Horne R, Gan SH. Translation, cultural adaptation and validation of the medication adherence report scale (MARS-5) in Nepalese cancer patients experiencing pain. J Pain Res. 2024;17:3741–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Shrestha S, Kc B, Blebil AQ, Teoh SL. Pharmacist involvement in cancer pain management: A systematic review and Meta-Analysis. J Pain. 2022;23(7):1123–42. [DOI] [PubMed] [Google Scholar]
- 19.Yamada M, Miyamoto T, Jimaru Y, Torii S, Mitsuba N, Muraki Y, Takahashi K. Impact of interventions by certified pharmacists for outpatients with cancer pain on hospital admission after the introduction of opioid analgesics. Biol Pharm Bull. 2024;47(10):1746–50. [DOI] [PubMed] [Google Scholar]
- 20.Shrestha S, Iqbal A, Teoh SL, Khanal S, Gan SH, Lee SWH, Paudyal V. Impact of pharmacist-delivered interventions on pain-related outcomes: an umbrella review of systematic reviews and meta-analyses. Res Social Administrative Pharmacy: RSAP. 2024;20(6):34–51. [DOI] [PubMed] [Google Scholar]
- 21.Horinouchi A, Enokida T, Suzuki S, Kamata H, Kaneko A, Matsuyama C, Fujisawa T, Ueda Y, Ito K, Okano S, et al. A pharmacist-led opioid de-escalation program after completion of chemoradiotherapy in locally advanced head and neck cancer. Front Oncol. 2023;13:1145323. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.El-Haddad C, Hegazi I, Hu W. Understanding patient expectations of health care: A qualitative study. J Patient Experience. 2020;7(6):1724–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Richmond J, Anderson A, Cunningham-Erves J, Ozawa S, Wilkins CH. Conceptualizing and measuring Trust, Mistrust, and distrust: implications for advancing health equity and Building trustworthiness. Annu Rev Public Health. 2024;45(1):465–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Sara LF, Ylva W, Marit S, Anna E. The significance of communication and treatment expectations in cancer care: an interview study with cancer care practitioners. Integr Cancer Ther. 2025;24:15347354251370781. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Ferreira DC, Vieira I, Pedro MI, Caldas P, Varela M. Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Volume 11. Basel, Switzerland: Healthcare; 2023. 5. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Table S1: Pain Treatment Satisfaction Questionnaire
Supplementary Table S2: Cancer Pain Treatment Follow-up Satisfaction Questionnaire
Data Availability Statement
The data that support the findings of this study are available from the corresponding author, Dong Yu, upon reasonable request.