Embedding expectation effects on the management of cancer pain and related symptoms: A focus review.

As of 2022, an estimated 18 million individuals in the United States were living as cancer survivors, a number projected to rise to approximately 26 million by 2040. Advances in treatment and early detection have improved the 5-year cancer survival rate from 35% in 1960 to 65% today. However, cancer treatment often takes its own toll, and multi-modal treatments can have life-long consequences themselves, particularly in the form of chronic pain, which is known to compound the physical and emotional burden of cancer. In this review, we examine the complex burden of cancer-related pain, using breast cancer as a representative case. We first outline current pain management strategies, then highlight emerging non-pharmacological approaches that show promise in enhancing treatment outcomes. Among these, placebo effects and specifically, the role of the patient's expectations, represent compelling and safe avenues for non-pharmacological modes of symptom relief. Critically, we position expectation modulation not as a substitute but as an adjuvant to pharmacological interventions, targeting the psychosocial dimensions of pain without adding to the side-effect burden. Finally, we explore virtual reality and other extended reality technologies as innovative tools for delivering expectation-based interventions, offering scalable, immersive, and engaging platforms for integrated management of pain and other symptoms.