{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:21:18Z","timestamp":1787736078210,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fondazione Nora e Alberto Gentili"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Curr. Oncol.","Current Oncology"],"abstract":"<jats:p>Background: Cancer pain remains highly prevalent and undertreated despite established guidelines. In Italy, Law 38\/2010 mandates systematic pain assessment, yet only 26% of clinicians routinely evaluate pain at each clinical visit, and fewer than one-quarter have received formal training in pain medicine or palliative care. A national multidisciplinary roundtable, convened in Rome in March 2025, formally identified four systemic gaps\u2014insufficient education, fragmented care pathways, unclear professional roles, and challenges in implementing shared diagnostic and therapeutic pathways\u2014and planned the development of a structured Delphi consensus. Methods: A Delphi consensus process was undertaken in accordance with CREDES guidelines. The Steering Committee, comprising representatives of six Italian scientific societies (AIRO, AIOM, AISD, Federdolore-SICD, SICP, ACD-SIAARTI) and a patient advocacy group (Fondazione Nora e Alberto Gentili), developed 15 clinical statements addressing pain assessment, management, referral criteria, monitoring, and documentation over five online meetings held between March and September 2025. Sixty-six Italian clinicians from various specialties were invited to participate; the survey was open from 1 October to 31 December 2025, with reminders every 10 days. Consensus was defined as \u226575% agreement (scoring 4 or 5 on a 5-point Likert scale). Results: Fifty-six clinicians completed the survey (response rate: 84.8%), representing medical oncology, radiation oncology, pain therapy, and palliative care specialties; individual statements were rated by 53\u201354 panelists, as skipping single items was permitted. All statements reached consensus in the first round (77.8\u2013100%), precluding the need for a second voting round. Panelists\u2019 qualitative comments informed minor wording refinements; substantial content was unchanged. Conclusions: The Delphi process produced a validated, multidisciplinary clinical pathway for cancer pain management in the Italian National Health System (NHS). The pathway establishes structured roles for the clinical reference physician and specialist consultants, objective decision thresholds for analgesic titration and referral, and minimum requirements for standardized pain documentation. These consensus-based statements provide actionable clinical guidance that may help address analgesic undertreatment and support the implementation of Law 38\/2010 across Italian oncology centers.<\/jats:p>","DOI":"10.3390\/curroncol33090507","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:11:15Z","timestamp":1787731875000},"page":"507","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expert Consensus Develops Multidisciplinary Pathway for Cancer Pain Management in Italy: A Delphi Study"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2145-2300","authenticated-orcid":false,"given":"Francesco","family":"Cellini","sequence":"first","affiliation":[{"name":"Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Universita Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Consoletti","sequence":"additional","affiliation":[{"name":"Pain Management Unit, \u201cPoliclinico Riuniti\u201d University Hospital of Foggia, 71122 Foggia, Italy"},{"name":"Federdolore\u2013Italian Society of Pain Clinicians (SICD)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-3785","authenticated-orcid":false,"given":"Massimo","family":"Di Maio","sequence":"additional","affiliation":[{"name":"Department of Oncology, AOU Citta della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy"},{"name":"Italian Association of Medical Oncology (AIOM), 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Maria Michele","family":"Fornasari","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"The Italian Association for the Study of Pain, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Fortini","sequence":"additional","affiliation":[{"name":"Integrated Palliative Care Unit, ASST Sette Laghi, 21100 Varese, Italy"},{"name":"The Italian Society of Palliative Care (SICP), 20124 Milan, Italy"},{"name":"Palliative Care and Pain Therapy, DG Welfare, Lombardy Region, 20100 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Gentili","sequence":"additional","affiliation":[{"name":"Fondazione Nora e Alberto Gentili ETS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2064-8379","authenticated-orcid":false,"given":"Marco","family":"Krengli","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35122 Padua, Italy"},{"name":"Division of Radiotherapy, Veneto Institute of Oncology IOV IRCCS, 35122 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Maranzano","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Perugia, 06123 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Natoli","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Pain Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI)\u2014Section of Pain Medicine and Palliative Care, 00184 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Cancer Pain Management in Italy Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Snijders, R.A.H., Brom, L., Theunissen, M., and van den Beuken-van Everdingen, M.H.J. 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