Association Between Opioid Use and Survival Time in Patients With Unresectable Pancreatic Cancer

Oh, Tak Kyu; Hwan, Sang; YOON, Yoo-Seok; Song, In Ae

doi:10.1097/mpa.0000000000001094

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…In Table 1 , we found that PDAC patients in 0.375%-0.5% ropivacaine group received increased opioid dosing and Cox proportional model demonstrated that total opioid dose was not a prognostic factor. However, previous literatures showed that reduced opioid dosing would potentially improve perioperative immune function and postoperative long-term survival 22 , 23 . Thus, difference in opioid dose may not account for survival benefit of high dose ropivacaine.…”

Section: Discussionmentioning

confidence: 99%

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

Chen

Zhang

et al. 2021

J. Cancer

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Background: Previous literatures have demonstrated that regional anesthesia such as epidural anesthesia may affect long-term survival of cancer patients. In the present study, we conducted a retrospective cohort study to investigate the survival impact of intraoperatively epidural ropivacaine infusion on pancreatic ductal adenocarcinoma (PDAC) patients. Methods: PDAC patients who underwent pancreatic surgery in Zhongshan Hospital Fudan University from January, 2015 to June, 2018 were included. The surgical procedure was performed under combined endotracheal general anesthesia and thoracic epidural anesthesia, and patient-controlled epidural analgesia (PCEA) with 0.12% ropivacaine was given after surgery for further pain control. Patients were divided into two groups according to their intraoperative epidural ropivacaine concentration: high (0.375%-0.5%) and low (0.15%-0.25%). Survival outcome was compared between groups. Results: A total of 215 patients were enrolled and their baseline characteristics were balanced between groups, except that patients with high concentration ropivacaine received higher total dose opioid and had longer operative time. Resected PDAC patients who were administrated with high concentration ropivacaine through epidural catheter intraoperatively had improved overall survival (median overall survival, mOS, high VS low, 37.6 VS 23.7 months, p=0.04). High epidural ropivacaine concentration was an independent prognostic factor (hazard ratio [HR]=0.65, 95% confidence interval [CI], 0.44-0.94; p=0.03). Subgroups analyses shown that T3M0 PDAC patients with preoperative CA 19-9 higher than 200 U/ml, negative resection margin, and those without tumor deposit and adjuvant radiotherapy could benefit from high concentration of ropivacaine. Conclusion: Intraoperatively epidural infusion with high concentration of ropivacaine was associated with improved OS in PDAC patients undergoing pancreatectomy.

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Section: Discussionmentioning

confidence: 99%

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

Chen

Zhang

et al. 2021

J. Cancer

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“…Opioids and its derivatives are widely used for the management of pain in PC. A large retrospective study found a negative correlation between opioid usage and survival time in patients with unresectable tumors [3]. Population based studies from an area in Iran with high opium consumption rate proposed opium to increase risk of PC [7,8].…”

Section: Plos Onementioning

confidence: 99%

“…The five year survival rate for PC remains dismal (~10%), partly due to asymptomatic progression of the disease with a majority (~85%) of the patients having nonsurgically resectable disease at the time of diagnosis [2]. More alarming is the ongoing increase a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 in the PC incidence which will place the disease as the second cause of cancer mortality by the end of this decade [3]. Discovering risk factors contributing to PC can aid with identifying high risk groups that would benefit from implementation of preventive and possibly screening strategies, which could help in reduction of the disease burden and/or early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Opioid use as a potential risk factor for pancreatic cancer in the United States: An analysis of state and national level databases

et al. 2021

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Pancreatic cancer (PC) rate is increasing in the U.S. The use of prescription and illicit opioids has continued to rise nationally in recent years as well. Opioids have been shown to have a deleterious effect on multiple types of cancer with recent data suggesting opium use as a risk factor for PC. Using national databases, we tested whether opioid usage pattern over time could explain the state and national-based variations in PC rates in the U.S. Opioid death rate (as a surrogate for prescription and illicit opioid use) was extracted from the CDCs Wonder online data through the Vital Statistics Cooperative Program. Incidence of pancreatic cancer was retrieved from the online CDCs data base gathered from the U.S. Cancer Statistics Working Group. Prevalence of obesity, tobacco and alcohol use was collected from Behavioral risk factor surveillance system. Mixed-effects regression models were used to test the association between levels of PC rate and opioid death/use rates during the years 1999–2016. A rise in PC was seen over time at the national and state levels. Similarly, the opioid death rates increased over time. Among other potential PC risk factors, only obesity prevalence showed an increase during the study period. A state’s opioid death rate at 4 years prior significantly predicted initial incidence of PC (β = 0.1848, p<0.0001) and had a significant effect on the estimated annual change in the rate of PC (β = -.0193,p<0.0001). Opioid use may be an un-identified risk factor contributing to the increasing incidence of PC in the U.S. These novel findings need to be verified by population-based studies.

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“…To our knowledge our study is the first prospective study to show the independent effect of using opium on PC survival. Several retrospective studies have shown the vicious effects of opioid use on survival time in different cancer types including PC [35], gastric cancer [36], and lung cancer [37]. In two other retrospective studies of patients with advanced incurable cancers opioid use was independently associated with shorter survival [38,39].…”

Section: Plos Onementioning

confidence: 99%

Survival features, prognostic factors, and determinants of diagnosis and treatment among Iranian patients with pancreatic cancer, a prospective study

et al. 2020

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Objectives Investigating the survival features, and determinants of treatment and stage at presentation in Iran Methods 461 patients with pancreatic ductal adenocarcinoma (PC) were prospectively enrolled from Shariati hospital, Tehran, Iran, between 2011–2018. All patients underwent endoscopic ultrasonography, computed tomography scanning, and physical examination. Validated questionnaire was completed for the participants and all were actively followed on monthly basis. Results Median survival time was 6.5 months, and 1-, and 5-year survival rates were 26.2%, and 1.5%. Patients who were older (p<0.001), illiterate (p = 0.004), unmarried (p = 0.003), rural inhabitant (p = 0.013), opium user (p = 0.039), and had lower body mass index (BMI) (p = 0.002) had lower overall survival. Tumors located in the head of pancreas were more commonly diagnosed at lower stages (p<0.001). Only 10.4% of patients underwent surgery who were more commonly educated (p<0.001), married (p = 0.005), had a tumor located in the head of pancreas (p = 0.016), and were diagnosed at lower stages (p<0.001). After adjustment for potential confounders and risk factors, rural inhabitance (HR: 1.33 (95% CI: 1.01–1.74)), having more symptoms (HR for each increasing symptom: 1.06 (1.02–1.11)), using opium (HR: 1.51 (1.04–2.20)), having a tumor located in the body of pancreas (HR: 1.33 (1.02–1.75)), and having an advanced tumor stage (HR: 2.07 (1.34–3.19)) remained significantly associated with increased risk of mortality. After the adjusting for potential confounders, we did not find significant relationships between smoking, alcohol intake, and BMI with the risk of death among patients with pancreatic cancer. Conclusions Iranian patients with PC have very poor long-term survival. Besides tumor’s stage and location, socioeconomic disparities could affect the probabilities of receiving treatment and/or survival in these patients. Opium use is an independent risk factor for mortality among PC patients in Iran.

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Association Between Opioid Use and Survival Time in Patients With Unresectable Pancreatic Cancer

Abstract: Correlations between patient survival, initial opioid dose, final opioid dose, and the rate of increase of opioid dosage could provide useful information for clinicians treating unresectable pancreatic cancer patients.

Cited by 20 publications

References 22 publications

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study

Opioid use as a potential risk factor for pancreatic cancer in the United States: An analysis of state and national level databases

Survival features, prognostic factors, and determinants of diagnosis and treatment among Iranian patients with pancreatic cancer, a prospective study

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