Authors (including presenting author) :
Au LSJ (1), Wong SY (2), Chan CWT (2), Chan SY (1), Yuen KK (1)
Affiliation :
(1) Department of Clinical Oncology, Queen Mary Hospital (2) Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital
Introduction :
The Intrathecal Drug Delivery System (IDDS) has emerged as a promising alternative for managing refractory cancer pain, particularly in advanced cancer patients who are intolerant to oral opioids or have failed less invasive pain interventions. By delivering analgesics directly to the central nervous system, IDDS provides effective pain relief at significantly lower doses than systemic opioids, reducing associated side effects. Since 2022, the Departments of Clinical Oncology and Anaesthesia, Pain and Perioperative Medicine at Queen Mary Hospital have jointly introduced IDDS, with 15 cancer patients receiving implants to date. As its use expands, a practical, evidence-based guideline is essential to ensure safe implementation across clinical settings.
Objectives :
This departmental guideline aims to establish a standardized workflow for IDDS implantation and highlight critical safety considerations during radiotherapy and MRI. It also offers quick-reference solutions for common pump-related complications to promote consistent, efficient, and safe patient care.
Methodology :
A comprehensive literature review was conducted to evaluate the safety of IDDS in relation to ionizing radiation exposure, MRI compatibility, and device-related complications. Sources included prospective studies, retrospective reviews, case reports, institutional guidelines, manufacturer manuals, and safety advisories. Development of the guideline involved a multidisciplinary team of oncologists, anesthesiologists, physicists, radiographers, and nursing staff.
Result & Outcome :
The resulting clinical guideline provides structured workflows and addresses key safety concerns through the following sections: (1)Clinical Workflow: Covers referral, admission, peri-operative preparation, discharge precautions, and Clinical Management System (CMS) alerts. (2)Radiotherapy Planning Precautions: Recommends planning techniques and highlights the importance of in-vivo dose measurements to mitigate device malfunction. (3)MRI Compatibility and Safety: Details conditions for safe scanning and outlines post-MRI pump interrogation protocols to confirm normal function. (4)Post-Mortem Device Removal: As the pump may explode during cremation, safe removal procedures and consent processes are clearly defined. (5)Common Troubleshooting: Offers algorithms for managing postoperative fever, opioid withdrawal, suspected overdose, and local swelling over the pump or spinal wound. This multidisciplinary protocol represents a significant advancement in the safe delivery of intrathecal therapy for cancer patients. By addressing key procedural and imaging-related risks, it provides a model for standardized, high-quality care. Ongoing staff training, patient education, outcome evaluation, and periodic updates will ensure continued improvement and sustainability.
