A doctor contemplating the complex landscape of cancer pain management and morphine use.

Cancer Pain Management: Are Oncologists in China Missing the Mark?

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Lena Voss in Health & Wellness October 2026 • 4 min read.

"New research reveals critical gaps in oncologists' knowledge and attitudes towards morphine use for cancer pain, highlighting a need for better training and awareness."


For cancer patients, pain is a significant concern that considerably reduces their quality of life and affects their confidence in cancer treatment. Morphine, a potent analgesic, is a cornerstone in managing severe cancer pain. The World Health Organization (WHO) recognizes morphine consumption as a critical indicator of a country's commitment to cancer pain control.

While morphine use has increased in China since the implementation of WHO guidelines in 1990, it still lags behind developed nations. This discrepancy points to potential gaps in knowledge, attitudes, and clinical practices surrounding morphine usage among healthcare professionals.

A new study investigates Chinese oncologists' understanding of cancer pain and morphine's clinical applications. It also highlights the factors hindering the optimal use of this essential pain medication in the People's Republic of China.

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Morphine in Severe Cancer Pain

Oral morphine remains the drug of choice for managing severe cancer pain under the WHO analgesic ladder, according to the cited article. The source identifies its role in severe pain management but provides no prevalence figures or other statistics about cancer pain's impact.

Stepwise Care and Treatment Limits

A cited treatment summary describes a stepwise approach beginning with oral morphine at 5–15 mg for opioid-naïve patients, scheduled around-the-clock dosing, and additional breakthrough doses. It also recommends coanalgesics such as antidepressants or anticonvulsants for neuropathic pain. Radiotherapy, hormonotherapy, chemotherapy, and surgery can relieve pain in some cancer patients, while evidence for treating breakthrough cancer pain with certain approaches remains limited. The available sources also describe assessment, opioid risk management, side-effect prevention, and non-opioid analgesics as parts of cancer-pain care.

Key Findings: Knowledge Gaps and Misconceptions

A doctor contemplating the complex landscape of cancer pain management and morphine use.

The study, which surveyed 127 oncologists from Tianjin Medical University Cancer Institute and Hospital, revealed some critical insights. While a significant percentage (75.6%) reported a comprehensive understanding of the WHO guidelines for cancer pain relief, a considerable number still lacked familiarity or had only basic knowledge.

Specifically, the research identified a few critical areas where oncologists struggled:

  • Target Analgesic Effects: Only 30.7% of oncologists correctly answered questions about the target effects of morphine, suggesting a misunderstanding of the ultimate goals of analgesic treatment.
  • Dosage Misconceptions: A substantial percentage believed in a maximum dose limit for morphine in cancer patients, which contradicts established pain management principles.
  • Indications for Morphine: Over a third of respondents were unclear about the appropriate indications for morphine usage, indicating a potential failure to fully implement the WHO's three-step guidelines.
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Opioids, Methadone, and Morphine Questions

A December 2023 article describes opioid analgesics as a mainstay of cancer-pain management. A systematic review and network meta-analysis covering 16 studies and 1,813 patients, with follow-up from 5 to 35 days, suggests methadone may merit further promotion as a first-line option for cancer-related pain. Separate 2025 reports describe a meta-analysis examining morphine's effects on survival, death, and cancer recurrence, while noting that its influence on tumor progression and prognosis remains unresolved.

Limits in the Evidence and China Data

A 2024 review reports promising results for methadone added to morphine or other opioids for cancer-related pain, but says those results came from retrospective case reports and case series. That evidence base is therefore limited in the source's description. A separate study on cancer-pain awareness and communication states that its data collection was limited to mainland China, a geographic boundary relevant when interpreting its findings.

These findings suggest that, despite increased awareness of international guidelines, there are still significant gaps in oncologists' practical knowledge about morphine and its application in cancer pain management.

Addressing the Barriers: A Call for Action

The study underscores that Chinese oncologists need more comprehensive knowledge and have misconceptions regarding cancer pain treatment and morphine's clinical application. The findings point to the crucial role of professional training initiatives in improving morphine use for cancer pain treatment.

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Morphine's Meaning Shapes Its Use

A 2020 qualitative study found that participants' views of morphine were influenced by prior experience. Patients and caregivers commonly saw it as a strong analgesic that could reduce suffering, while associating it with end-stage illness and dependence. The study also reported openness to future morphine use for comfort and effective pain relief. Another synthesis describes concerns about morphine's symbolism, addiction, and tolerance among patients, carers, and clinicians, including the perception that starting morphine can signify impending death.

Market Projections for Cancer Pain Care

One market report estimates that cancer-related pain management will account for 28.5% of the global medical morphine market in 2026. Another values the cancer pain market at USD 4.2 billion in 2024 and projects it to reach USD 7.8 billion by 2034, a stated compound annual growth rate of 6.4%. That report attributes projected growth to rising global cancer incidence, greater awareness of pain-management protocols, and an expanding older population. These are market estimates and projections reported by the sources.

Relief, Side Effects, and Care Experiences

A 2016 case report describes morphine as effective for cancer pain and notes that it can cause nausea, vomiting, constipation, and, rarely, respiratory depression. Research at an outpatient cancer center examined how patients, caregivers, and oncology professionals experienced palliative care and communication about symptom management, with pain and its management emerging as particularly salient. A retrospective cohort study at Ningbo First Hospital analyzed pain levels and opioid use in relation to cancer-specific survival among advanced cancer patients, using records from June 2013 through October 2017. A separate qualitative study explored attitudes toward morphine among patients with advanced cancer and their caregivers.

The research identified key barriers to widespread morphine use, including insufficient training for medical personnel, poor patient compliance, concerns about drug side effects, and fear of addiction. All these factors need to be addressed directly through targeted educational and communication strategies.

By implementing comprehensive training programs and addressing misconceptions, healthcare systems in China can significantly improve cancer pain management and enhance the quality of life for patients in need.

Patient reports and physician perceptions in cancer pain care

  • 78.8% of 477 patientsIn a Beijing survey, 78.8% of 477 patients with cancer reported moderate to severe pain in the previous 24 hours: 42.4% moderate and 36.3% severe.[1]
  • 52.5%; 43%In an Asian physician survey, 52.5% of 463 physicians viewed patients’ reluctance to report pain as an important barrier; in a separate survey, 43% of 100 physicians perceived this reluctance.[2]
  • 57.2%; 14.4% of medical staffA clinical-practice survey reported that 57.2% of medical staff were unfamiliar with opioid dose titration and rotation, while 14.4% treated cancer pain through multidisciplinary collaboration.[3]
  • 432; 45.06%Among 959 lung cancer patients with exact death dates, 432 received at least one opioid prescription at the end of life, reported as 45.06% (95% CI: 44.36%–45.77%).[4]

How other cancer-pain reports compare

A historical controlled survey reported that 67% of cancer pain was undertreated and that patients in China reported greater pain severity and interference than patients in contemporaneous studies in the United States and France. This provides a broader comparison, but it does not establish present-day rates.[5]

What remains unclear about cancer-pain care

  • The evidence identifies prescribing regulation and access to strong analgesics as obstacles, but does not show how much each contributes to inadequate pain control.[4]
  • An analysis of opioid prescriptions near the end of life explicitly leaves unresolved whether lung cancer pain is properly managed in that setting in China.[4]
  • A report on cancer pain awareness says that specific improvement strategies remain ambiguous in the absence of a recent reassessment of pain and treatment in mainland China. The evidence therefore leaves open how patterns have changed over time.[5]
  • The outpatient survey described in the evidence was conducted at a tertiary hospital in southwestern China, so its setting alone cannot establish whether its findings represent other care settings.[6]

Sources

  1. Practices and Hindrances in Cancer Pain Management: Results of a National Multi-Cancer Center Survey Among Healthcare Professionals in China (pmc.ncbi.nlm.nih.gov)
  2. Cancer pain management in China: current status and practice implications based on the ACHEON survey (pmc.ncbi.nlm.nih.gov)
  3. Knowledge, Practices, and Perceived Barriers in Cancer Pain Management at Oncology Units: A Cross-Sectional Survey of Medical Staff in China (pmc.ncbi.nlm.nih.gov)
  4. Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China (pmc.ncbi.nlm.nih.gov)
  5. Psychological distress and cancer pain: Results from a controlled cross-sectional survey in China (pmc.ncbi.nlm.nih.gov)
  6. Pain and Its Treatment Among Outpatients with Malignant Tumors in China (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

Why is cancer pain management important, and what is the role of morphine in it?

Cancer pain is a significant issue for patients undergoing cancer treatment, and it severely impacts their quality of life. Morphine, a potent analgesic, is a key medication in managing severe cancer pain, as recognized by the World Health Organization (WHO). The study revealed that a lack of understanding of this critical aspect, particularly among oncologists in China, can lead to inadequate pain management and, ultimately, decreased patient confidence in their treatment.

2

What is the significance of the World Health Organization (WHO) guidelines and morphine consumption in the context of cancer pain management in China?

The World Health Organization (WHO) recognizes morphine consumption as a critical indicator of a country's commitment to cancer pain control. Despite the implementation of WHO guidelines in 1990, China's morphine use lags behind developed nations. This gap reflects potential knowledge gaps, attitudes, and clinical practice issues among healthcare professionals, which hinders effective pain management and patient care.

3

What key findings from the study highlight the gaps in oncologists' knowledge about cancer pain and morphine use?

The study surveyed 127 oncologists from Tianjin Medical University Cancer Institute and Hospital and found that a significant percentage (75.6%) reported a comprehensive understanding of the WHO guidelines for cancer pain relief. However, considerable gaps remain in practical knowledge, particularly concerning the target analgesic effects of morphine, dosage misconceptions, and indications for its usage. This includes a misunderstanding of the ultimate goals of analgesic treatment and the appropriate situations for morphine administration. The findings point to the crucial role of professional training initiatives in improving morphine use for cancer pain treatment.

4

What are the specific areas of knowledge gaps and misconceptions regarding morphine identified in the study?

Target Analgesic Effects refer to the desired outcomes of morphine use, such as pain relief and improved patient comfort. The study revealed that only 30.7% of oncologists correctly answered questions about the target effects of morphine. Dosage Misconceptions involve beliefs about maximum dose limits for morphine in cancer patients, which contradicts established pain management principles. Indications for Morphine refer to the specific medical conditions or situations where morphine is appropriate for use, guided by the WHO's three-step guidelines. Over a third of respondents were unclear about the appropriate indications for morphine usage.

5

What are the implications of these findings, and what actions are needed to improve the situation?

The findings underscore that Chinese oncologists need more comprehensive knowledge and have misconceptions regarding cancer pain treatment and morphine's clinical application. The study emphasizes the crucial role of professional training initiatives in improving morphine use for cancer pain treatment. Addressing these gaps through education and training can lead to better pain management for cancer patients, improved quality of life, and increased confidence in their cancer treatment.

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