The impact of pain and opioids use on survival in cancer patients

Abstract

The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association. A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models. A total of consecutive 203 cancer patients were included in the cohort study. Kaplan–Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival. We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.

Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

“… 56 The medical use of opioids may be associated with a shortened survival in advanced cancer patients, but cause and effect relationship remains uncertain and decisions should be guided by goals of care, patient prognosis and risk–benefit assessment of the treating physician. 57 , 58 …”

When Management of Cancer-Related Pain Is Complicated by Coexisting Opioid Use Disorder

“…Alternatively, avoiding or severely limiting opioids when managing cancer pain in patients with use disorders when pain is not adequately controlled by nonopioid therapies is likely to have a significant negative impact on quality of life and well-being and could lead to use of opioids being obtained and used illegally. In addition, poorly controlled cancer pain correlates with decreased survival 25,26 . There are times when OUD is so severe that even with multiple safeguards in place, it is deemed too dangerous to treat cancer pain with opioid medications 27 .…”

“…In addition, poorly controlled cancer pain correlates with decreased survival. 25,26 There are times when OUD is so severe that even with multiple safeguards in place, it is deemed too dangerous to treat cancer pain with opioid medications. 27 Ideally, oncologists and their patients would have access to experts such as addiction medicine, pain and palliative care specialists, as well as mental health providers with additional training in the complexities of addiction to safely navigate this tight rope.…”

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

“…Long-term recent studies have described that pain and quality of life deteriorate in the first 3 months following surgery, but pain is generally improved from then on [31][32][33]. Whilst previously accepted as part of the course of the disease, pain is increasingly recognized as a significant problem, both from functional and survival viewpoints [34,35]. Furthermore, there is little data about long-term opioid use in patients undergoing pelvic exenteration for a locally advanced pelvic malignancy, which has further implications in terms of opioid-induced immunosuppression and other systemic adverse effects as a result of chronic opioid dependence [36].…”