Background Intrathecal drug delivery systems(IDDS) may represent an effective option for these patients with moderate-to-severe intractable cancer pain. Proper patient selection, drug selection and management are very important for the safety and effectiveness of IDDS analgesia. So far, there is no universally accepted program though recommendations from an interdisciplinary expert panel had published. Objective The purpose of this review to provide updates on cancer patients’ selection and drugs seletion for IDDS, and aim to provide the new idea for IDDS in cancer pain by reviewed newly relative literatures and clinical studies. Content The advent of new algorithmic tracks for nociceptive pain and neuropathic pain is an important step in improving cancer patient analgesia. Preimplantation trialing may be unnecessary for cancer IDDS. Patients with less than 3 months of life expectancy are also accepted for IDDS in the new recommendations. Trend With increasing survival rate in cancer, the prevalence of cancer pain is also increasing in number. The specialist advocates for a much wider application of IDDS therapy to provide effective analgesia for patients with cancer pain, including those at the end of life.