ORIGINAL ARTICLE Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit Sebastiano Mercadante & Costanza Guccione & Simona Di Fatta & Valentina Alaimo & Giovanna Prestia & Rosanna Bellingardo & Vittorio Gebbia & Antonino Giarratano & Alessandra Casuccio Received: 1 February 2013 / Accepted: 26 June 2013 / Published online: 26 July 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Background This survey was performed to draw information on pain prevalence, intensity, and management from a sam- ple of patients who were admitted to an oncologic center where a palliative care unit (PCU) has been established for 13 years. Methods Cross-sectional survey in an oncological depart- ment performed 1 day per month for six consecutive months. Results Of the 385 patients, 69.1, 19.2, 8.6, and 3.1 % had no pain, mild, moderate, and severe pain, respectively. Inpatients and patients with a low Karnofsky score showed higher levels of pain intensity (p <0.0005). One hundred twenty-eight patients with pain or receiving analgesics were analyzed for pain management index (PMI). Only a minority of patients had negative PMI score, which was statistically associated with inpatient admission (p =0.011). Fifty of these 128 patients had breakthrough pain (BTP), and all of them were receiving some medication for BTP. Conclusion It is likely that the presence of PCU team pro- viding consultation, advices, and cultural pressure, other than offering admissions for difficult cases had a positive impact on the use of analgesics, as compared with previous similar surveys performed in oncological setting, where a PCU was unavailable. This information confirms the need of the presence of a PCU in a high volume oncological department. Keywords Chemotherapy . Opioid . Pain Introduction Pain is a common symptom experienced by cancer patients with wide variations according to the primary diagnosis and disease stage, the prevalence of pain being more than 70 % in advanced stages [28]. Despite available treatments and the development of effective guidelines for the management of cancer pain, proven effective in the majority of subjects [15, 27], a large proportion of cancer patients remain undertreated due to barriers related to health care resources, patient, and family [10, 16]. However, misconceptions about opioids, S. Mercadante (*) : G. Prestia : R. Bellingardo Anesthesia & Intensive Care and Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, and Palliative Medicine, University of Palermo, Via S. Lorenzo 312, 90145 Palermo, Italy e-mail: terapiadeldolore@lamaddalenanet.it S. Mercadante e-mail: 03sebelle@gmail.com C. Guccione Faculty of Pharmacy, University of Palermo, Palermo, Italy S. Di Fatta Medical School, University of Palermo, Palermo, Italy S. Mercadante : V. Alaimo : A. Giarratano Anesthesia and Intensive Care Unit, Ospedale Giglio, Cefalù, Italy V. Gebbia Department of Oncology, La Maddalena Cancer Center, Palermo, Italy A. Casuccio Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy S. Mercadante : V. Alaimo : A. Giarratano Chair of Anesthesiology, University of Palermo, Palermo, Italy Support Care Cancer (2013) 21:3287–3292 DOI 10.1007/s00520-013-1899-z