Use of opioid analgesics or sleeping medication and survival of cancer patients

Chang, Wen–Pei

doi:10.1016/j.ejon.2014.11.007

Cited by 14 publications

(5 citation statements)

References 65 publications

(68 reference statements)

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“…[2][3][4][5][6] Opioids, used to reduce pain, [7] might reduce immunity and survival, which might limit their use and increase suffering. [8][9][10][11][12][13] A systematic review showed that, although findings from individual studies were variable, opioids tended not to affect survival in the last days to weeks of life, but there was a possible association with shorter survival with longer term opioid-use. [14] These were mostly poor quality studies where the effect of opioids on survival was not the primary outcome.…”

Section: Introductionmentioning

confidence: 99%

The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.

Boland

Allgar

Boland³

et al. 2019

Eur J Clin Pharmacol

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Purpose Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making. Methods Secondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death. Results Date of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6–49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 24% co-analgesics. Opioid-use was associated with decreased survival in the multivariable model (HR = 1.59 (95% CI:1.38–1.84), p < 0.001). An exploratory subgroup analysis of those with C-reactive protein (CRP) measures (n = 219) indicated higher CRP was associated with poorer survival (p = 0.001). In this model, the strength of relationship between survival and opioid-use weakened (p = 0.029). Conclusion Opioid-use and survival were associated; this relationship weakened in a small sensitivity-testing subgroup analysis adjusting for CRP. Thus, the observed relationship between survival and opioid-use may partly be due to tumour-related inflammation. Larger studies, measuring disease activity, are needed to confirm this finding to more accurately judge the benefits and risks of opioids in advanced progressive disease.

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Section: Introductionmentioning

confidence: 99%

The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.

Boland

Allgar

Boland³

et al. 2019

Eur J Clin Pharmacol

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“…Twelve studies described various populations on chronic opioid therapy from large US healthcare or insurance databases (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Manuscripts in this section entailed a wide range of subpopulations including patients receiving opioids and benzodiazepines for chronic non cancer pain (n=7) (29)(30)(31)(32)(33)35,37), cancer pain (n=1) (38), psychiatric disorders (n=2) (28,34), HIV positive patients (n=1) (36) and patients with end stage chronic obstructive pulmonary disease (n=1) (39). Most manuscripts reported about the interaction of opioids with benzodiazepines, but interactions between opioids and gabapentin, alcohol, cocaine and muscle relaxants were also reported.…”

Section: Ambulatory Healthcarementioning

confidence: 99%

“…The data from this group entailed the biggest proportion of studies included in this review. On average, these were large database studies conducted in various subpopulations, which shared the setting of representing out-of-hospital or ambulatory healthcare (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). The data uniformly indicated that combined use of opioids and sedatives (mostly benzodiazepines, but also gabapentin, alcohol, muscle relaxants, cocaine, etc.)…”

Section: Ambulatory Healthcare Settingsmentioning

confidence: 99%

Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events

Boon¹,

Dorp²,

Broens³

et al. 2020

Ann Palliat Med

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Opioids and benzodiazepines are increasingly used alone or in combination. However, the combined use of these agents increases the risk for potentially lethal respiratory depression. This review summarizes current evidence on the effects of the combined use of opioids and benzodiazepines on mortality and severe respiratory adverse events. The results of 29 included manuscripts showed that concomitant use of opioids and benzodiazepines increased the risk for these outcomes in most of clinical and non-clinical settings. However, the risk for harm and benefit of the drug combination strongly correlates to its context and there are situations, such as in the hospice setting, where benefits may outweigh the risks.

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“…Previous studies that examined the adverse health effects of sleep medications in cancer survivors were limited because they included data from a single academic hospital, were based on patient with various types of cancer, or did not address confounding factors such as comorbidities or use of antidepressants [9][10][11][12][13]. In sum, sparse populationbased data exist about these serious sequelae of prescription…”

Section: Introductionmentioning

confidence: 99%

Sleep medication use and risk of fractures in breast cancer survivors

Haque

Chlebowski

Chen

2021

Breast Cancer Res Treat

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Purpose Sleep problems are more common in breast cancer survivors than those without a cancer history. Our goal was to examine the risk of fractures among breast cancers survivors who used prescription sleep aids. Methods We conducted a retrospective cohort study of 21,346 adult women diagnosed with stage 0–III breast cancer between 2009 and 2016 and followed them through 2017. We examined person-year rates of fractures by sleep medication use and calculated adjusted hazard ratios (HR) and 95% confidence intervals (CI) with Cox proportional hazards models using time-dependent variables for sleep medications and covariate medications (antidepressants, anti-anxiety medications, and bisphosphonates) adjusted for demographics, comorbidities, and tumor characteristics and cancer treatments. Results The sleep medication use was common (40%) in breast cancer survivors and was associated with a 33% increased risk of fractures (adjusted HR = 1.33, 95% CI: 1.20–1.49). Further, in a sensitivity analysis based on new use of sleep medication, the fracture risk was even stronger (adjusted HR = 1.44, 95% CI: 1.26–1.64). Conclusion Given the high use of sleep medications and the high risk of fractures in breast cancer survivors, this study suggests that non-pharmacologic management of sleep problems might be considered as alternative therapy.

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Use of opioid analgesics or sleeping medication and survival of cancer patients

Cited by 14 publications

References 65 publications

The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.

The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.

Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events

Sleep medication use and risk of fractures in breast cancer survivors

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