Takaaki Hasegawa1, Tetsuya Oguri2, Tomohiro Osawa3, Toshiyuki Sawa4, Satoshi Osaga5, Toru Okuyama1,6, Megumi Uchida1,6, Ken Maeno2, Satoshi Fukuda2, Hirotada Nishie1, Akio Niimi2, Tatsuo Akechi1,6. 1. 1 Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital , Nagoya, Japan . 2. 2 Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan . 3. 3 Department of Pharmacy, Gifu Municipal Hospital , Gifu, Japan . 4. 4 Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital , Gifu, Japan . 5. 5 Clinical Research Management Center, Nagoya City University Hospital , Nagoya, Japan . 6. 6 Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan .
Abstract
BACKGROUND: Preclinical studies show that opioids promote angiogenesis, tumor progression, and metastasis, resulting in shorter survival. OBJECTIVE: To explore whether opioids are associated with the overall survival (OS) of patients with incurable nonsmall cell lung cancer (NSCLC). DESIGN: Prospective cohort study of patients with NSCLC. SETTING: We investigated patients newly diagnosed with advanced or post-operative recurrent NSCLC between April 2013 and December 2015 at a single institute. MEASUREMENTS: We evaluated OS, opioid requirements, opioid doses, pain levels, and prognostic factors of advanced NSCLC. The effects of variables on survival were analyzed using univariable and multivariable models. Patients were stratified according to oral morphine equivalents (OMEs)/day (<60 or ≥60 mg) to assess the association between opioid dose and OS. RESULTS: We analyzed 150 patients, including 64 who received opioid treatment during follow-up. The median OS was 242 days in the opioid group and 627 days in the no-opioid group (log-rank p < 0.001). Multivariable models revealed that the opioid requirement was an independent predictor of shorter OS, after adjustment for prognostic variables, including sex, histology, stage, history of systemic chemotherapy, and performance status (hazard ratio 1.73, 95% confidence interval 1.137-2.631). There was no significant difference in OS between patients who received ≥60 mg OME/day for 250 days versus <60 OME/day for 242 days. CONCLUSIONS: The opioid dose does not shorten the survival of patients with advanced NSCLC. The opioid requirement is associated with shorter survival when opioids are administered any time during the clinical course, independent of the influence of other key factors.
BACKGROUND: Preclinical studies show that opioids promote angiogenesis, tumor progression, and metastasis, resulting in shorter survival. OBJECTIVE: To explore whether opioids are associated with the overall survival (OS) of patients with incurable nonsmall cell lung cancer (NSCLC). DESIGN: Prospective cohort study of patients with NSCLC. SETTING: We investigated patients newly diagnosed with advanced or post-operative recurrent NSCLC between April 2013 and December 2015 at a single institute. MEASUREMENTS: We evaluated OS, opioid requirements, opioid doses, pain levels, and prognostic factors of advanced NSCLC. The effects of variables on survival were analyzed using univariable and multivariable models. Patients were stratified according to oral morphine equivalents (OMEs)/day (<60 or ≥60 mg) to assess the association between opioid dose and OS. RESULTS: We analyzed 150 patients, including 64 who received opioid treatment during follow-up. The median OS was 242 days in the opioid group and 627 days in the no-opioid group (log-rank p < 0.001). Multivariable models revealed that the opioid requirement was an independent predictor of shorter OS, after adjustment for prognostic variables, including sex, histology, stage, history of systemic chemotherapy, and performance status (hazard ratio 1.73, 95% confidence interval 1.137-2.631). There was no significant difference in OS between patients who received ≥60 mg OME/day for 250 days versus <60 OME/day for 242 days. CONCLUSIONS: The opioid dose does not shorten the survival of patients with advanced NSCLC. The opioid requirement is associated with shorter survival when opioids are administered any time during the clinical course, independent of the influence of other key factors.
Authors: Jason W Boland; Victoria Allgar; Elaine G Boland; Mike I Bennett; Stein Kaasa; Marianne Jensen Hjermstad; Miriam Johnson Journal: Eur J Clin Pharmacol Date: 2019-12-21 Impact factor: 2.953
Authors: M V Verschueren; C M Cramer- van der Welle; M Tonn; F M N H Schramel; B J M Peters; E M W van de Garde Journal: Sci Rep Date: 2021-12-02 Impact factor: 4.379