Too Little, Too Late: Rethinking IDDS as a First-line Strategy in Cancer Survivorship

More than 18 million Americans are living with a history of cancer, and that number is rising. Yet intrathecal drug delivery systems (IDDS), one of the most powerful tools in the neuromodulation arsenal, remain dramatically underutilized in cancer survivors. Deployed late, often after years of inadequate systemic analgesia, IDDS is still widely treated as a last resort rather than a proactive, function-restoring intervention. This 60-minute expert panel challenges that paradigm directly. Convening leading neuromodulation specialists, the session draws on the landmark 2024-2025 Polyanalgesic Consensus Conference (PACC) cancer pain guidelines, which explicitly recognize a growing survivorship population with stable disease and decades of predicted survival, to make the clinical, pharmacological, and ethical case for deploying IDDS earlier in the treatment algorithm. Through real patient cases and interactive panel discussion, faculty will address the questions that keep clinicians up at night: When does waiting for IDDS become clinically indefensible? Who among our survivors is the right candidate, and how do we identify them earlier? What drug strategies are uniquely suited to patients who may live with a pump for 20 years? And how do we build the referral pathways that make earlier intervention possible? This is not a theoretical debate. With published research showing a 54% decline in IDDS use for cancer pain between 2014 and 2024, and survivorship pain representing one of the fastest-growing unmet needs in the field, this session delivers actionable clinical guidance that attendees can implement immediately.