Telehealth in home-based cancer pain management: a narrative review

Introduction

Cancer pain, a common and debilitating symptom of cancer and a side effect of cancer related treatment, affects almost half of the patients who are diagnosed with various types of cancer (1). It may be caused by invasion, metastasis, and compression of the primary tumor or emerge with cancer related treatment (2), thus often necessitating sufficient and individualized pain management. Despite advanced medical theories and techniques, the prevalence and intensity of cancer pain remain escalating and poorly managed as reported in recent reviews (1,3). Traditionally, hospitalized pain management requires substantial medical resources and financial support. Therefore, the development of home-based pain management offers greater convenience and cost-effectiveness for both providers and patients (4). However, as demand for more convenient and patient-centered healthcare continues to grow, current approaches remain limited in terms of timeliness, intelligence and individualization. Fortunately, advances in remote healthcare, commonly referred to as telehealth, are rapidly transforming this landscape.

Telehealth, a way to receive healthcare remotely through electronic devices, was evolved from the concept of Telemedicine, first defined by Thomas Bird in the United States in 1970s (5). In 2022, the World Health Organization defined telehealth as the “delivery of health care services, where patients and providers are separated by distance” (6). Based on information and communication technologies, telehealth exceeds traditional healthcare in multifaced aspects, including exchange of information for the diagnosis and treatment of diseases and injuries, supporting research and evaluation, and for the education of health professionals.

Originally envisioned as a means to enhance healthcare accessibility (7), telehealth has also demonstrated its potential in reducing mortality rates, improving clinical outcomes, increasing healthcare system efficiency, and delivering economic benefits (8). Recent researches (9-12) have increasingly focused on the integration of telehealth with home-based pain management, which offers a natural foundation in relation to the population and its needs. Furthermore, with the participation of artificial intelligence (AI) (13), telehealth exhibits great potential in the future.

This narrative review explored the characteristics and roles of telehealth in home-based cancer pain management, as well as the advancements and progress of its wide implementation. By meticulously analyzing the benefits and limitations of telehealth in this context, this review summarizes the general principles and the particular landscape of telehealth in pain medicine, offering new insights and methodologies for future research endeavors, while these principles may vary according to care stage, cancer types and patient age. We present this article in accordance with the Narrative Review reporting checklist (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-2026-0023/rc).

Methods

Search strategy and information sources

We conducted a focused literature search for studies published in the last 15 years on telehealth interventions for home-based management of cancer pain. Databases searched included PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search terms combined controlled vocabulary and free text for telehealth (telehealth, telemedicine, telemonitoring, mHealth, eHealth, digital health, mobile app, video consult, telephone), cancer (cancer, neoplasm, oncology), pain (pain, cancer pain, analgesic, anesthesia), and home care (home, home-based, home care, community). Limits: human studies, English, published within the past 15 years. The search strategy is summarized in Table 1.

Eligibility criteria

For a narrative review, we included randomized and non-randomized trials, cohort or pre-post studies, qualitative analysis, systematic reviews that evaluated telehealth interventions (synchronous or asynchronous consults, remote monitoring, apps, telephone) and narrative reviews aimed at home-based management of cancer pain. Excluded were conference abstracts and inpatient-only studies.

Quality assessment

Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardized form (study design, year, sample, scale, outcomes), and a simplified, domainbased quality assessment (limits and recommendation) was performed (Table S1). Two reviewers independently completed the assessment; any disagreements were resolved by discussion or, if necessary, adjudicated by a third reviewer. Findings were synthesized narratively by intervention type and outcome, prioritizing randomized controlled trials (RCTs), systematic reviews and large sample scale studies; pilot studies were only used to illustrate feasibility.

Cancer pain management

Current situation of cancer pain

In 2022, approximately 20 million new cancer cases were reported worldwide, with an upward trend each year (14). Cancer pain is a complex and multifaceted type of pain experienced by patients with cancer. According to the definition made by International Association for the Study Pain on cancer pain in 2019 (15), cancer pain is classified as chronic pain caused by the primary cancer itself or metastases (chronic cancer pain), or its treatment (chronic post-cancer treatment pain).

Although not necessarily inevitable for every patient diagnosed with cancer, it occurs commonly across different cancer types and clinical stages. Moreover, many patients experience severe breakthrough pain, which further complicates pain management. While the incidence and severity of cancer pain have decreased since 2016, the overall occurrence remains substantial, with 44.5% of cancer patients affected, and 30.6% (1) enduring moderate to severe pain. Furthermore, cancer pain often encompasses physical, emotional, and psychological components, significantly impacting the patients’ quality of lives (16).

Currently, cancer pain remains a persistent challenge throughout the cancer survival journey, intensifying as the tumor advances. Thus, effective management of cancer pain requires comprehensive approaches tailored to specific conditions and actual needs of these patients.

The evolving paradigm of home-based cancer pain management

Recently, there have been remarkable advances in the management of cancer pain, shifting from conservative treatment to proactive intervention and transitioning from the clinician-centered care to the patient-centered paradigm.

The inclusion of the new classification for cancer pain in the International Classification of Diseases has facilitated more accurate diagnosis and treatment (15), thus elevating the efficacy and efficiency of pain management, especially in low- and middle-income countries and regions. In clinic, the recent focus has shifted from a primarily pharmacological approach to a more comprehensive and individualized mode (17), underscoring the importance of patient-reported outcomes (PROs) as recommended in a 2022 guideline (18). This shift is particularly evident in opioid use (19,20), which has transitioned from a focus on general dosage to a greater emphasis on individualized titration to reduce the risk of misuse and abuse.

Additionally, there has been a growing interest in non-pharmacological treatment (21,22) for pain management, reflecting broader understanding on the complicated pain experience. As indicated in a narrative review (19), the concept of integrative pain care reveals a shift in perception, suggesting more proactive interventions in pain management. Moreover, as a result of healthcare cost-containment strategies, the preference for home-based management of cancer pain in patients has been shown to be both beneficial and pain-relieving in both end-stage and long-term survival settings (4,23).

Apart from these proactive and individualized transitions, the integration of technologies, such as telehealth and AI, holds promise for improving access to healthcare and individualizing treatment strategies. However, it inevitably brings new challenges that must be carefully settled.

Overview of telehealth

Definition

Telehealth refers to the delivery of healthcare services using digital communication technologies, including video conferencing, remote monitoring and mobile health apps (24). According to the U.S. Health Resources and Services Administration in 2022, it encompasses a broad range of services, including long distance clinical healthcare, patient and professional health-related education, health administration, and public health services. While often used interchangeably with telemedicine (25) which specifically denotes remote clinical services, telehealth covers a broader scope, integrating non-clinical applications such as provider training and administrative meetings (26).

Initially designed to bridge gaps in rural and underserved areas (27), telehealth leverages audiovisual tools to facilitate remote provider-patient interactions and reduce the needs for in-person visits (26). Specifically, it enables services like remote diagnosis, chronic disease management, and mental health counseling. In addition, the coronavirus disease 2019 (COVID-19) pandemic accelerated its adoption, highlighting its role in ensuring continuity of health care while minimizing infection risks (28).

Tools enabling telehealth include secure video platforms, wearable devices for real-time monitoring, and electronic health records for data sharing (29). By integrating these tools, telehealth can significantly improve accessibility, efficiency, and patient adherence, though regulatory and technological barriers remain before its full-scale implementation.

Development and application in medicine

As an application of information and communication technologies in healthcare, telehealth has been widely implemented across multiple medical specialties such as chronic disease management (30), mental health (31), obstetrics (32), oncology (33), and nursing practice (34). It is worth noting that telehealth has emerged as an important strategy in chronic diseases management, demonstrating substantial effectiveness in improving patient adherence, clinical outcomes, health-related quality of life, and disease control, as well as reducing hospitalization rates (35,36). For example, a randomized clinical trial (37) showed the comprehensive telehealth use improved multiple outcomes in patients with diabetes at a reasonable additional cost compared to telemonitoring coordination, indicating its great value in managing chronic diseases.

Despite rapid development, telehealth currently faces multiple challenges including complex regulatory environments (38), insufficient technological infrastructures (39), barriers to adoption by providers and patients (40), and the digital divide (41). Therefore, future directions involve reforming policies and regulations, fostering technological innovation and enhancing training and education. Integrating hybrid care models (42) that combine in-person and remote services will be crucial to establishing telehealth as a fundamental component of modern healthcare systems, thereby expanding its coverage and optimizing patient experience.

Application of telehealth in home management of cancer pain

As noted above, telehealth is now available in a variety of modalities and plays a crucial role in managing chronic conditions. With technological progress and increasing expectations for better quality of life, there has been a sharp rise in the demand for managing cancer pain at home (43,44). In this context, integrating telehealth with home-based pain care shows great potential to improve patient outcomes and experiences, as well as to open up new directions in clinical practice (Figure 1). Table 2 provides a curated selection of high-quality evidence that supports in the following parts.

Figure 1 Summary of concept: illustration of how telehealth functions in home-based cancer pain management via tight connections and cooperation among different parties. AI, artificial intelligence; PROs, patient-reported outcomes.

Remote symptom monitoring and real-time assessment

In contrast to traditional in-person manners, telehealth facilitates remote symptom monitoring and real-time assessment with the aid of advanced digital technologies. As an essential component of remote symptom monitoring, facial expression recognition of pain has made significant advances. A 2022 study introduced a deep-learning system designed to recognize moderate to severe pain [numerical rating scale (NRS) ≥4] (53), demonstrating sensitivities of 89.7% for detecting pain levels ≥4/10 and 77.5% for levels ≥7/10. A 2025 systematic review revealed that digital technology-driven models for assessing facial expressions related to pain offer a more objective, precise, and efficient alternative to traditional methods (45). For those who are receiving palliative care and unable to report pain appropriately, facial expression recognition can serve as a valuable tool. For patients in non-palliative settings, it may also be a useful adjunctive assessment tool.

As a real-time assessment tool, the PainCAS platform functions through online questionnaire. By recording patient pain intensity and opioid usage data, this platform can help evaluate individual pain fluctuations and opioid usage history (46), which promoted medical efficiency (47) and optimized the personal experience (54). Moreover, Pain-QuILT (55) enables patients to self-report various characteristics and intensities of pain throughout their entire body, owning the advantage to overcome the barrier that often prevents patients from expressing the complex sensations associated with chronic pain. Other customized platforms like Colorect Along platform, specially designed for colorectal cancer patients in non-palliative settings, achieved a high average satisfaction level (8.03 out of 9) (56), indicating broad acceptance in these patients. Furthermore, Biofourmis’ PainFocus integrates machine learning with internet-connected monitoring to enable longitudinal, quantitative assessments of individual pain trajectories through continuous measurement of key physiological signals (57). This may help facilitate early detection of clinical deterioration and improve pain management over time. This kind of innovation could be particularly valuable for patients receiving palliative care.

In addition to the clinical-related convenience, telehealth such as aforementioned tools and platforms can save costs to some extent in terms of healthcare economics (48). For patients suffering from cancer pain, the financial burden significantly adds to their difficulties, especially before telehealth became available. A 2023 research focused on cost savings associated with telehealth indicated that the estimated mean total cost savings ranged from $147.4 to $186.1 per telehealth visit (58). Furthermore, these economic benefits can perpetually extend to remote palliative care, which is likely essential during the final stage of cancer patients suffering from pain, as suggested in a review from 2022 (59). Therefore, this could be an important topic for future research to examine the relationship between cost saving and pain relief through telehealth.

Personalized interventions and smart pain management

Unlike face-to-face healthcare, telehealth enables providers to deliver individualized cognitive-behavioral interventions to patients with cancer pain at home. A 2019 randomized noninferiority trial on cancer pain (60) indicated that videoconference based mobile health pain coping skills training was more convenient and equally effective compared to traditional face-to-face training. Similar conclusions were found in a 2025 RCT regarding acceptance and commitment therapy in patients with breast cancer (61), which was delivered via video calls. Moreover, the evaluation of the feasibility and acceptability of telehealth interventions for these patients shows several promising outcomes (62,63), suggesting the reciprocal benefits for both providers and patients. However, given the limited subgroup analysis available, their actual effectiveness may differ across patient groups according to cancer type and age. It is worth noting that, in addition to psychological interventions, individualized medical education can also help in alleviating pain and reducing opioid usage, as shown in recent studies (64-66). These studies suggest that an accurate understanding of cancer pain benefits both providers and patients during personalized interventions.

Another notable example is the Collaborative Health Outcomes Information Registry (CHOIR), a smart pain management system that provides providers a mobile workstation for clinical use. Unlike online pain assessment tools, this workstation integrates multiple modules (49) including pain intensity assessment, opioid use record, individualized medical recommendations, and clinical decision support. Likewise, WeChat mini programs can serve as mobile, convenient platforms with the potential to improve pain management (67,68) in China. As a social media application, WeChat is widely used and therefore has significant advantages in promoting medication adherence (67,69). In fact, 93.7% participants were satisfied with mobile app-based pain management in a 2019 RCT (70). Owing to their convenience and paperless nature, providers can access more information to support clinical decision-making, thus contributing to better outcomes (71). Taken together, these systems may be suitable for patients in non-palliative settings due to their timeliness and consistency across platforms, which could support better pain management. For patients receiving palliative care, close pain monitoring and early detection of clinical deterioration are more important. However, further studies with extended follow-up periods are still needed to comprehensively address multidimensional PROs in both palliative and non-palliative settings.

Besides, with the availability of wearable devices and virtual reality (VR) technology, VR-delivered pain management has made rapid progress (72). By means of skin conductance response, heart rate variability and electroencephalography, pain detection via wearable devices can achieve accuracy of 72.1%, 84%, and 91.84% respectively (73-75). A 2025 randomized crossover trial showed VR significantly reduced pain intensity and interference (76) compared to control groups though patients with cancer pain were excluded. Another 2025 pilot study (77) indicated chronic cancer pain could be alleviated by daily use of VR-delivered distraction therapy, showing the potential of non-pharmacological VR intervention in cancer pain management. Thus, future researches are imperatively needed to further evidence its feasibility and effectiveness.

Provider and patient empowerment

In the adoption of telehealth for home-based cancer pain management, providers’ effective intervention and patients’ active participation, namely empowerment of both sides, is indispensable all the time. A satisfactory pain control relies on timely communication and effective self-management, which is as important as medication selection. However, patient empowerment may be less pronounced among patients receiving palliative care, where symptom burden and declining functional status may limit the extent to which empowerment can be achieved. In addition, cancer type and patient age may also influence this process and should be considered in clinical practice.

Telehealth can strengthen patients’ empowerment by improving relevant knowledge and skills in pain management (78) as noted above. This may enable patients to actively track symptoms (50,51) and facilitate shared decision-making with providers (52). For instance, app-based realtime PROs allow patients to monitor overall trends and participate more actively in care decisions with providers, according to a 2021 systematic review (51). In this review, a total of 41 apps were screened and majority of them were free to use in spite of the limited number of those specifically targeting cancer pain (51). These apps can also shorten response time: patients who report increasing pain intensity may receive timely medical interventions (79) such as rescue medication or referrals without waiting for in-person visits. This may effectively reduce suffering and emergency department visits.

For providers, telehealth can expand their capacity to deliver responsive, guidelineconcordant pain management in the community (80). Remote access to chronologically ordered PROs and continuously monitored data has the potential to improve diagnostic accuracy regarding pain patterns and adverse effects. This, in turn, could facilitate data-driven drug titration and promote safer opioid stewardship, despite the existing gaps in high quality evidence (81). Besides, decisionsupport tools embedded in telehealth platforms, for example, dose calculators, risk stratification dashboards, and alerts for emergent symptoms, can help standardize healthcare and reduce cognitive burden. Furthermore, Rendle developed the Framework for Integrating Telehealth Equitably (FITE) (82) to guide equitable telehealth into practice in 2024. This framework coordinates interdisciplinary efforts among diverse stakeholders, providing better support for patients with cancer pain and sharing caregiving responsibilities across the community rather than placing them solely on individuals.

It is noteworthy that the rapid advances of AI have brought new opportunities to provider and patient empowerment (83), which is deeply reshaping the landscape of pain medicine. For instance, the use of interactive AI to offer psychological support is an important area of ongoing research (84). Despite the fact that these are not all designed specifically for cancer pain, they still hold the promise to become one of the supportive options for home-based management in the future.

Implementation challenges: beyond technology

Technical and data security

Although the application of telehealth has gained wide acceptance among patients, it still necessitates a certain standard of professional guidance and electronic equipment to ensure its effective functioning. This results in barriers among the elderly individuals and low-income populations, hindering widespread access across extensive regions (85). Consequently, it is particularly imperative to notice the digital divide for providers when introducing telehealth.

Besides, in terms of data security, patient privacy may be more vulnerable with telehealth, even though most data are strongly encrypted. Hacks like illegal data transmission persist in spite of restrictions of laws and regulations. For providers and patients, it is necessary to prepare for these potential risks, but fortunately giant entities remain reliable in general.

Clinical workflow integration

For healthcare providers, it is pivotal to collect accurate data so that they can make subsequent decisions about patients’ pain intensity and overall conditions. Otherwise, the data inaccuracy will result in an unreliable diagnosis and treatment based on potentially misguiding measurements if ignored by providers (24,86). As mentioned before, the existing digital divide may magnify the data inaccuracy and unreliability challenges, thereby deteriorating provider-patient relationship.

Another limitation is the potential risks associated with long distance medical interventions in telehealth compared with in-person care. Rapid and effective solutions are needed in emergencies such as serious apnea resulting from possible opioid overdose, which requires close monitoring and prompt professional intervention. The question is, who is responsible for this and how to standardize the definition of “Emergency”? Also, the relative concerns of remote opioid usage including regulation, misuse and compliance still require appropriate solutions.

In addition, given the limited evidence available, stratified remote monitoring and pain management strategies remain underexplored. Therefore, future studies should evaluate whether remote monitoring and pain management strategies need to be adapted for specific cancer types and for pediatric, adult, and older patient populations.

Provider-patient relationship

Telehealth has transformed both the structural and procedural dimensions of primary healthcare, particularly regarding the physical environments in which interactions take place. This innovation has created a new context that requires adaptation from both providers and patients (87). The tangible interactions between providers and patients undeniably play an irreplaceable role in promoting the provider-patient relationship, and even sometimes pain relief itself. Therefore, it becomes a dilemma for both groups without such emotional and supportive interactions if not properly dealt with or compensated.

In addition, it is crucial to underscore the importance of humanistic care. For instance, the neglect of this aspect, as seen in the advanced anesthesiology robot Sedsays (88), entails a quick failure in a very short term.

Policy and economy considerations

Currently, a substantial obstacle to telehealth is the licensure of its providers. It is pivotal for providers to access special licensures relating telehealth from the authority, even though they already have processed medical licenses (89). Fortunately, reforms are ongoing as reported recently: Providers will be waived licensing and geographic restrictions to telehealth within certain federal programs such as Medicare (90). In China, similar reforms and explorations are underway to devise the most effective strategies as well (91). Along with policy making, pursuing reimbursement stands as a crucial legislative and regulatory initiative for providers. Therefore, sustainable integration of reimbursement into payment is imperatively needed to ensure the successful and equitable access to telehealth (92). It is hoped that the incorporation of advanced technologies like AI and blockchain will offer a transformative perspective on the current landscape.

Future directions

AI-driven predictive tools are rapidly transforming the delivery of healthcare: In a 2025 study published on arXiv, computer scientific related researchers achieved impressive accuracies of 87.4% and 91.7% in predicting pain episodes within 48 and 72 hours of hospitalization respectively (93). In the pre-AI era, it takes time-consuming and resource-intensive endeavor to manage the PROs and related data to conduct a predictive analysis for providers, even with the assistance of various online tools. By collecting and analyzing data from remote monitors and PROs, providers can offer real-time guidance while crafting comprehensive pain profiles for each individual, leading to more precise, individualized, and lower-risk pain management (83).

Although AI has proved its great potential in telehealth as evidenced by recent reviews (94,95), larger scale and multi-center studies assessing its feasibility and reliability remain lacking to standardize the guideline. Moreover, ethic concerns such as biases and transparency in integrating AI into telehealth must be carefully addressed (96), let alone privacy security (97), which requires new technologies like blockchain and sufficient attention placed on it.

Another noteworthy direction is the hybrid care models. First defined and evolved in 1960–70s, developed in COVID-19 pandemic episode, hybrid care models combine in-person and virtual care with digital technologies (98,99) including AI and telehealth. Currently, it is suitable for not emergent but still important cases to get the healthcare in need. For patients, hybrid care models can improve convenience and provide both mental and physical support through community engagement. For providers, this model may facilitate communications among interdisciplinary care teams, specialists, primary care, and community-based organizations. This may smooth timely care coordination and information sharing but more large-scale, high-quality clinical studies are still needed to support these findings.

Although the above approaches have shown promise in general, their implementation may differ across cancer types and age groups in clinical practice. Given limited direct evidence to support detailed stratified recommendations, future studies should focus on subtype-specific or age-specific protocols beyond the general principles.

Conclusions

Telehealth was once perceived merely as a supplementary and temporary solution for remote areas (100). However, it has dramatically transformed the landscape of healthcare with significant advantages in economy, convenience, feasibility, and intelligence, thereby expanding the reach of traditional medical care. The current situation of cancer pain management encounters significant barriers in both timeliness and efficiency, resulting in enormous financial and medical burdens on society each year. Fortunately, supported by well-trained medical professionals, patients suffering from cancer pain can benefit from telehealth through videos, websites, applications, and even robots. Recent studies (101-103) have shown that telehealth seamlessly integrates pain assessment, analysis, treatment, and follow-up functions via various platforms, including mobile phones, laptops, and tablets, offering patients more convenient connections to medical services. With these benefits, telehealth holds immense potential to significantly impact home-based cancer pain management, even though several challenges and limitations must be addressed moving forward.

In conclusion, this review highlights the recent progress and general principles of telehealth empowered home-based cancer pain management. Their practical application should be adjusted individually according to the care stage, while evidence is still limited regarding cancer type and age-specific recommendations.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-2026-0023/rc

Peer Review File: Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-2026-0023/prf

Funding: This work was supported by the Key Public Health (Supporting) Discipline in Hongkou District, Shanghai (No. HKGWZD202401), the Outstanding Young Talent Training Program in Public Health, Hongkou District, Shanghai (No. HKGWYQ2024-06), and the Discipline Promotion Project: Prevention, Diagnosis, and Treatment of Postherpetic Neuralgia (No. SY-YKYTS-2024-2002).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-2026-0023/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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