Anesthetic Use and Cancer Recurrence in the Surgical Oncological Patient: An Integrative Review

Abstract

This integrative review compared anesthetic usage and its impact on the cancer patient.Immunosuppression from anesthesia can have major impacts on the human body's immune system and lead to a decrease in overall patient survival and an increase in cancer recurrence rates. A search was completed using electronic databases including CINAHL, PubMed Health, and Medline Plus. The studies were located with keyword searches and inclusion and exclusion criteria was used to locate a final 8 studies for the review. A critical appraisal was completed using Polit and Beck's critical analysis tables, displaying key characteristics of the studies chosen. Outcomes reviewed included overall survival rates, cancer recurrence rates, time to recurrence and biomarker identification.The findings presented more beneficial outcomes with regional anesthesia, but larger prospective randomized studies are needed to validate these findings. Regional anesthesia has shown to increase time to recurrence, decrease recurrence rates, and limit the increase in immune biomarkers. However, regional anesthesia does not fully support an increase in overall survival rates. More research and randomized control trials are warranted on this topic. Overall, this integrative review has supported the use of regional anesthesia for more positive outcomes in the oncological surgical patient over general anesthesia. Anesthetics and Cancer Recurrence in the Surgical Oncological Patient:An Integrative Review of the Literature Background/Statement of the ProblemAn estimated 234 million surgeries are undertaken every year world-wide (Weiser et al., 2008) and of this 234 million, an estimated 20% are related to cancer (Hoekstra et al., 2015). Cancer is a global epidemic, being the leading and most common cause of death worldwide (Torre et al., 2015). This is amplified by the increasing age and growth of our population. The rise in cancer cases is strongly associated with an increase in sedentary lifestyles, poor diets and smoking (Torre et al., 2015). The word 'cancer' constitutes immediate negative connotations for valid reasons. Each year in the United States over 1 million cases of individuals diagnosed with cancer are recorded (Le-Wendling, Nin, & Capdevila, 2015). In 2012, 14 million new cancer cases were documented, and 8.2 million cancer deaths occurred globally (Torre et al., 2015). An additional 1.6 million cases were diagnosed in 2016 and of these cases an estimated 33% will die from the developed disease (Bharati, Chowdhury, Bergese, & Ghosh, 2016). These staggering figures provide us with a clear picture of why cancer remains one the leading causes of mortality in the world. Increased risk factors for cancer developmentThreatened populations. Certain populations are at greater risk for cancer development, such as men and the elderly. The incidence in North America of cancer in men versus (vs.) women was 344:295 out of 100,000 (Torre et al., 2015). The cancer mortality rate per 100,000 of men vs. women was 123:91 (Torre et al., 2015). The underlying re...