Association of opioid requirement and cancer pain with survival in advanced non-small cell lung cancer.

Zylla, Dylan; Kuskowski, Michael A.; Allam, Kiran; Gupta, Pankaj

doi:10.1200/jco.2014.32.15_suppl.e20631

Cited by 18 publications

(23 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Available data suggest that opioids influence vascular [ 6 ], pulmonary [ 7 , 8 ], and renal function [ 9 , 10 ] and cancer progression [ 6 ]. Our group (Gupta et al) found that higher opioid requirement was independently associated with shorter survival in patients with advanced prostate cancer [ 11 ] and lung cancer [ 12 ]. However, it remains to be determined whether high opioid use is a cause or consequence of this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Morphine for the Treatment of Pain in Sickle Cell Disease

Gupta

Msambichaka

Ballas

et al. 2015

The Scientific World Journal

View full text Add to dashboard Cite

Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. Experimental and clinical studies, even though extremely few, suggest that opioids may exacerbate existent organ damage and also stimulate pathologies of their own. Because of the recurrent and/or chronic use of large doses of opioids in SCD, it is critical to evaluate the role and contribution of opioids in many complications of SCD. The aim of this review is to initiate inquiry to develop strategies that may prevent the inadvertent effect of opioids on organ function in SCD, should it occur, without compromising analgesia.

show abstract

Section: Introductionmentioning

confidence: 99%

Morphine for the Treatment of Pain in Sickle Cell Disease

Gupta

Msambichaka

Ballas

et al. 2015

The Scientific World Journal

View full text Add to dashboard Cite

show abstract

“…Second, without complete original postoperative pain records, we cannot exactly exclude or evaluate the influence of pain factor. Zylla et al 44 reported pain was also a prognostic predictor of advanced NSCLC before chemotherapy. Third, the samples that use postoperative non-mu agonists seem a bit few.…”

Section: Discussionmentioning

confidence: 99%

Effect of mu Agonists on Long-Term Survival and Recurrence in Nonsmall Cell Lung Cancer Patients

Wang

et al. 2015

Medicine

View full text Add to dashboard Cite

Opioids are widely used for postoperative analgesia. Morphine may have an effect on cell replication, migration, and cancer recurrence. However, the association of postoperative mu agonists with outcome of nonsmall cell lung cancer (NSCLC) patients has not been fully investigated.We retrospectively evaluated the impact of postoperative mu agonists on overall survival (OS) and disease-free survival (DFS) in early stage NSCLC patients. Patients and relevant medical information were selected from the Bio-Bank of Shandong Provincial Hospital. Difference of clinicopathologic information in postoperative mu agonists group and no mu agonists group was analyzed by χ2 test. Univariate and multivariate Cox regression analysis were conducted and represented as hazards ratio and 95% confidence interval form. The primary endpoint was OS and secondary endpoint was DFS.This retrospective study included 984 consecutive NSCLC patients who underwent surgery between January 2006 and December 2011. No significant difference existed between postoperative mu agonists usage group and no mu agonists usage group in clinicopathologic information except operation type (P = 0.041). Postoperative mu agonists usage was related to shorter OS (HR 1.514, 95% CI 1.197–1.916, P = 0.001) and shorter DFS (HR 1.415, 95% CI 1.123–1.781, P = 0.003) in the multivariate Cox regression model. For the patients who received postoperative chemotherapy or radiotherapy postoperative mu agonists also predict shorter survival (HR 1.437, 95% CI 1.041–1.982, P = 0.027). Subgroup analysis showed that administration of postoperative mu agonists was related to shorter OS, especially in males, more smoking, poor differential degree, bilobectomy or pneumonectomy, and stage III subgroup, respectively.Administration of postoperative mu agonists was related to shorter OS and DFS for the NSCLC patients who underwent surgery.

show abstract

“…Only few human studies have investigated either the impact of opioids per se or the relevance of expression of MORs in tumors on oncological outcomes (Table 1). In patients with NSCLC, 4 retrospective studies have indicated an association between the use of opioids and poor recurrence free-and/or overall survival [7,[64][65][66] . Three of these studies evaluated the use of opioid in the perioperative period and one was conducted in patients with advanced disease [7,[64][65][66] .…”

Section: Human Studiesmentioning

confidence: 99%

“…Opioids are also often used in oncological patients with moderate-to-severe pain secondary to metastatic disease or complications related to chemotherapy or radiation [3][4][5] . Over the last decade, several investigations have pointed towards a potential negative impact of opioids in patients undergoing cancer surgery and in those with advanced malignancies [6][7][8] . Specifically, it has been suggested that the use opioids could be responsible for short-and long-term postoperative adverse events including immunosuppression and cancer recurrence [6,9] .…”

Section: Introductionmentioning

confidence: 99%

Opioids and cancer recurrence: a brief review of the literature

Cata

Bugada²,

Marchesini³

et al. 2016

Cancer Cell Microenviron

View full text Add to dashboard Cite

Opioids are the most commonly used analgesics during and after cancer surgery and in patients with advanced malignancies who suffer from moderate to severe pain. It has been suggested that opioids can promote cancer progression through different mechanisms including a direct effect on malignant cells, stimulation of angiogenesis and immunosuppression. In contrast, other studies have shown that opioids have anticancer effects. The results of clinical studies remain controversial with some evidence indicating that a high expression of the mu opioid receptor is an independent factor of tumor progression while other studies indicate that the administration of opioids perioperatively is associated with cancer recurrence. Unfortunately, all those clinical studies are retrospective and suffer from significant confounding variables and biases. To date, there is no solid evidence to suggest the avoidance of opioids in cancer patients with moderate to significant with the goal of reducing cancer recurrence. Some authors have suggested the use of spinal administration of opioids in order to reduce systemic effects. Careful use of opioids should be advised to reduce side effects or hyperalgesia in relation to specific needs of the patients.

show abstract

Association of opioid requirement and cancer pain with survival in advanced non-small cell lung cancer.

Cited by 18 publications

References 37 publications

Morphine for the Treatment of Pain in Sickle Cell Disease

Morphine for the Treatment of Pain in Sickle Cell Disease

Effect of mu Agonists on Long-Term Survival and Recurrence in Nonsmall Cell Lung Cancer Patients

Opioids and cancer recurrence: a brief review of the literature

Contact Info

Product

Resources

About