Opioids and Breast Cancer Recurrence: A Systematic Review

Abstract

Breast cancer has the greatest epidemiological impact in women. Opioids represent the most prescribed analgesics, both in surgical time and in immediate postoperative period, as well as in chronic pain management as palliative care. We made a systematic review analyzing the literature’s evidence about the safety of opioids in breast cancer treatment, focusing our attention on the link between opioid administration and increased relapses. The research has been conducted using the PubMed database. Preclinical studies, retrospective and prospective clinical studies, review articles and original articles were analyzed. In the literature, there are several preclinical in vitro and in vivo studies, suggesting a possible linkage between opioids administration and progression of cancer disease. Nevertheless, these results are not confirmed by clinical studies. The most recent evidence reassures the safety of opioids during surgical time as analgesic associated with anesthetics drugs, during postoperative period for optimal cancer-related pain management and in chronic use. Currently, there is controversial evidence suggesting a possible impact of opioids on breast cancer progression, but to date, it remains an unresolved issue. Although there is no conclusive evidence, we hope to arouse interest in the scientific community to always ensure the best standards of care for these patients.

Examining the interrelationships between mindfulness‐based interventions, depression, inflammation, and cancer survival

“…In addition to the detrimental effects of inflammation discussed above, there remain other concerns related to chronic opioid use and tolerance in patients living with cancer. Preclinical and retrospective studies suggest a possible link between opioid use and cancer metastasis or progression 41,45 . Possible mechanisms proposed include the activation of μ opioid receptors found in malignant cells and the stimulation of cell proliferation and angiogenesis 41 .…”

“…Some opioids have been shown to inhibit the activity and cytotoxicity of immune cells 41 . Notably, although several retrospective studies have shown that opioid use is associated with decreased survival in several cancer types, 46–49 this link has not been confirmed through prospective clinical trials, and opioids remain a primary component of cancer pain management 45,41,50,51 . Still, the inflammatory nature of pain and opioid use requires further investigation into their potential role in depression and poor outcomes.…”

“…Preclinical and retrospective studies suggest a possible link between opioid use and cancer metastasis or progression. 41,45 Possible mechanisms proposed include the activation of μ opioid receptors found in malignant cells and the stimulation of cell proliferation and angiogenesis. 41 Some opioids have been shown to inhibit the activity and cytotoxicity of immune cells.…”

“…41 Notably, although several retrospective studies have shown that opioid use is associated with decreased survival in several cancer types, [46][47][48][49] this link has not been confirmed through prospective clinical trials, and opioids remain a primary component of cancer pain management. 45,41,50,51 Still, the inflammatory nature of pain and opioid use requires further investigation into their potential role in depression and poor outcomes. Additional concerns remain regarding the adverse effects of opioid use in patients with cancer, including gastrointestinal side effects and the risks of abuse, diversion, and overdose.…”

Immunological Insights into Opioid-Free Anaesthesia in Oncological Surgery: A Scoping Review

“…A recent study reported a protective association between intraoperative opioid use and recurrence-free survival in triple negative breast cancer [ 10 ]. Conclusions of systematic reviews evaluating the effects of opioids in patients with cancer have a common theme: there is a lack of robust evidence and high-quality trials in humans [ 11 , 12 , 13 •]. Evaluation of the association between intraoperative opioid use and clinically relevant cancer outcomes is crucial to gain insight into how the cellular effects may affect longer-term outcomes, such as survival endpoints.…”