Abstract
BACKGROUND: Cancer-related pain is a prevalent and debilitating symptom that significantly impairs patients' quality of life, leading to physical discomfort as well as emotional and psychological distress. Despite the availability of effective pain control strategies, cancer pain remains inadequately managed worldwide. This challenge is multifactorial, involving barriers related to patients, healthcare providers, healthcare systems, and deficiencies in coordinated multidisciplinary care. METHODS: This systematic review followed the PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251027582). A comprehensive search of SCOPUS, PubMed, MEDLINE, EMBASE, ScienceDirect, the Cochrane Library, and Google Scholar was conducted for studies published between 2015 and 2025. Qualitative, quantitative, and mixed-methods studies examining barriers to cancer pain management from patient and healthcare professional perspectives were included. Study quality was assessed using the Newcastle-Ottawa Scale, and findings were synthesized narratively. RESULTS: A total of 244 records were identified, with 23 studies meeting the inclusion criteria after screening and eligibility assessment. Overall methodological quality was good, although most studies were cross-sectional. Four major categories of barriers were identified: patient-related, healthcare provider-related, healthcare system-related, and multidisciplinary care-related barriers. Patient-related barriers were most frequently reported fear of opioid addiction, concerns about side effects, under-reporting of pain, fatalistic beliefs, and cultural or religious influences. Provider-related barriers involved inadequate training, poor pain assessment practices, opioid-related concerns, and limited inter-professional communication. System-level barriers included restrictive opioid regulations, limited access to analgesics, staffing shortages, and lack of standardized protocols. Multidisciplinary barriers reflected poor care coordination, insufficient patient education, and lack of individualized pain management plans. CONCLUSION: Cancer pain management is hindered by interconnected barriers across patient, provider, and system levels. Addressing these challenges requires improved clinical practices, targeted professional education, balanced opioid policies, and strengthened multidisciplinary collaboration to enhance patient outcomes and quality of life.