He has participated in and led hundreds of clinical trial research projects in international and domestic centers. He is an international leader in the development of new domestic and foreign anti-tumor drugs, the application of modern scientific methods to elucidate the pro-immune effects of Fu Zheng Chinese medicine and the comprehensive treatment of lymphoma, small cell lung tumors and testicular tumors. He has published more than 320 academic papers. As a renowned expert in the field of oncology in China, Academician Sun Yan wears several hats – he is not only the Honorary President of the Asian Society of Clinical Oncology, but also the President of the Chinese Society of Medical Oncology. However, few people know that he is also a member of the Narcotic Drug Administration Committee of the State Food and Drug Administration. Therefore, in this interview with academician Sun Yan, we are not only talking about tumor prevention and treatment, but also about a heavier topic that cannot be avoided, that is, “cancer pain”. Most people only know the pain of cancer in terms of hair loss and vomiting of chemotherapy, but the cancer pain that occurs in the progress of cancer is even more terrible than the side effects brought by chemotherapy, and the pain that penetrates into the bone marrow makes many patients feel uncomfortable and want to die as soon as possible. The famous writer Ernest Hemingway was unable to bear the torture of cancer pain and chose to shoot himself. Although opioids have been able to help humans overcome cancer pain, misconceptions have made many patients’ lives worse than death. Recently, at the media communication meeting of “Painless Life, Quality Life” China Analgesia Week focusing on cancer pain, which was directed by the Medical Administration of the National Health and Family Planning Commission, the Publicity Department of the National Health and Family Planning Commission and the China Health Education Center, organized by China Health Science and Education Audio and Video Publishing House and supported by Mengti (China) Pharmaceutical Co. According to a set of data given by academician Sun Yan, there are more than 3.1 million new cancer patients in China every year, and the number of cancer pain patients is nearly 2 million. According to the results of the nationwide cancer pain survey conducted by the Ministry of Health, the incidence of cancer pain is 61.6%, and 34 advanced cancer patients are suffering from cancer pain. Facing the unfavorable situation of cancer pain treatment, Academician Sun Yan emphasized, “Cancer pain not only reduces the immunity of patients, but also brings great mental burden to patients. Many patients with advanced tumors often end up losing their will to live due to physical pain, and how to control pain has become an important part of cancer treatment, and even the only requirement for terminal cancer patients to pursue the final dignity of life.” Although since 2011, the Health Planning Commission has been leading the promotion of the Cancer Pain Standardized Treatment Demonstration Ward Project (GPM-Ward) nationwide, after four years of development, 735 cancer pain standardized treatment demonstration wards have been created in 28 provinces, municipalities and autonomous regions, which has strongly promoted the development of the cause of standardized cancer pain treatment in China. However, the current situation is that there is still an obvious gap between the standardized treatment level of cancer pain in China and that of advanced countries and regions: 70% of cancer pain patients in China still cannot receive adequate pain relief treatment; the knowledge and treatment skills of primary doctors are relatively lacking in cancer pain, and the level of cancer pain treatment varies significantly between urban and rural areas and between different regions, so the concept of standardized treatment of cancer pain needs to be further promoted nationwide. According to Academician Sun Yan, “Fear of addiction is the reason why doctors and patients are afraid to use opioid analgesics. Due to the opium war, everyone has no good feeling about opium and always thinks it will be addictive. I also had this thought block and felt that I didn’t know if I was harming or helping my patients by giving them opioids? However, after 20 years of specializing in this work, academician Han Jisheng wrote a banner for me, ‘Removing pain for the people is a noble cause’, advising me not to be afraid. My feeling is that once cancer pain is solved, cancer treatment is full of life.” There are misunderstandings between doctors and patients in analgesic treatment Pharmaceutical Economic News: According to what you know, what is the level of cancer pain treatment in China on a national scale? Sun Yan: The treatment of cancer pain is mainly pharmacological, and appropriate pharmacological treatment can make more than 90% of patients with moderate or severe cancer pain free from cancer pain and obtain a relatively high quality of life. At present, oral opioid analgesics are the first choice for cancer pain treatment, which is a worldwide consensus and recommended by the National Comprehensive Cancer Network (NCCN) and other authoritative institutions. However, China ranks only 83rd in the world and 19th in Asia in terms of medical opioid equivalent consumption, which is not proportional to the high incidence of cancer in China, which means that the cancer pain of many patients is not properly controlled and the standardized treatment of cancer pain in China is still a long way to go. Pharmaceutical Economic Daily: Very often, we learn from a lot of literature and movies and dramas that holding back pain seems to be more beneficial for disease recovery, and people worry about the various risks brought by analgesics. Then what do you think are the effects on cancer treatment if analgesic measures are not taken? Yan Sun: There was a consensus at the 10th International Congress on Pain (IASP) in 2002 that pain is the fifth vital sign after temperature, pulse, respiration and blood pressure, and that pain without timely relief will affect the quality of life of patients. Cancer pain is one of the most complicated mechanisms and a common clinical problem most easily ignored by doctors, patients and family members. Cancer pain can cause great physical and psychological pain to patients, which can reduce their physical function and immunity, as well as their ability to tolerate and receive tumor treatment, and affect their confidence and quality of life in anti-tumor treatment. Anti-pain and anti-cancer are equally important, and good anti-cancer treatment combined with anti-pain treatment can not only improve patients’ quality of life, but also significantly improve prognosis. The earlier cancer pain treatment is given, the better. At the very beginning of diagnosis, tumor patients should have their pain level, physical function and psychological status comprehensively evaluated by doctors, with the goal of controlling cancer pain and improving function, and carrying out standardized cancer pain treatment. And I can frankly say that our cancer patients are very lovely, they are very thirsty for life, and they will not abuse pain medication once their pain is solved, so our policy on narcotics is to meet the demand of medical treatment to the maximum extent, and now the prescription is very wide for us oncologists, and I can even prescribe two weeks of medication to some patients now, but of course I have to be very cautious and cannot give it indiscriminately. Pharmaceutical Economic Daily: Patients are very worried about addiction after taking these drugs, so from your medical experience, is there any risk of addiction when patients take analgesic treatment for cancer pain? However, the pain reflex of cancer patients is different from the central reaction of drug addiction in the brain of drug addicts, because the pain center of cancer patients is different from the addiction of drug addicts. We cancer patients don’t go after that feeling once the pain is stopped. I have been doing cancer research for half a century, and I have had a few patients who became addicted to narcotics. However, according to foreign data, 24,000 cases were investigated, of which 7 cases were addicted, accounting for 0.029%, and another data was investigated for 2,000 patients who used opiates, of which the addiction rate was only 0.033%. From my personal experience, I have seen countless patients over the past 50 years, but only 2 in 10,000 have become addicted, so from this data, there should be no further concern. From a clinical point of view, how should medication be administered to avoid addiction and achieve the goal of analgesia? Sun Yan: For cancer pain, WHO has recommended the three-step analgesic principle, and I was involved in the discussion of the three-step analgesic principle at that time. What is the principle of three-step analgesia? It is to divide the pain into three steps: mild, moderate and severe, and to use oral analgesics like aspirin instead of morphine for mild pain. When it comes to moderate pain, how to distinguish between mild and moderate pain is the business of our doctors. Moderate pain basically needs to be treated, but it is not good to tolerate without treatment, and it affects sleep. Severe pain, of course, the pain is more powerful, so moderate pain is the use of weak morphine opioid drugs, strong pain must be given morphine-based drugs. The second is to give the drug on time, whether it hurts or not, rather than waiting for the pain to give the drug again, which is a very important principle. It is also best to give convenient oral medication, which needs to be individualized, and to integrate other aspects of treatment, such as social, psychological, physical therapy, and even surgery, to form a complete pain relief treatment for cancer patients. I especially want to remind you that a patient’s pain is the most depleting, because the patient’s immune function decreases after pain, he cannot eat or drink, and he cannot rest well, so his whole body collapses. After solving the pain, it gives him a very good turnaround, so that he can be motivated to continue to receive other treatments, so that solving the pain is a key issue, and I think it is a very ethical thing since I have been doing this work. Medical Economics: In the future, what other work do you plan to do in promoting cancer pain treatment? What advice do you have for clinicians involved in cancer treatment? Sun Yan: We have held 800 training courses since 1900, and more importantly, our government has issued 8 red-headed documents for this purpose. It is rare for a cancer pain treatment to receive so much government support. In the future, the Professional Committee of Cancer Rehabilitation and Palliative Care of the Chinese Anti-Cancer Association and the Expert Committee on Rational Drug Use of the National Health and Family Planning Commission are cooperating to carry out the “Rational Drug Use Project for Standardized Cancer Pain Treatment”, hoping to improve the standardized treatment of cancer pain in China. More than 80% of cancer patients will experience different degrees of pain throughout the disease development process. Of course, some pains are brought by the disease itself due to the infiltration of tumor to local organs, some are brought by the treatment, and more pains are caused by bone pain due to multiple bone metastases. Cancer pain not only affects the quality of life of the patients themselves, but also affects the quality of life of their whole families. In fact, what is the “fear of cancer” that we often discuss? It is the fear of pain. Advanced cancer pain is often unbearable. As medical workers, we must find ways to treat both the disease and the heart of cancer patients, and we must find ways to help cancer patients relieve cancer pain and control cancer pain while treating the primary disease.