Boland, J, Ziegler, L, Boland, E et al. (1 more author) (2015) Is regular systemic opioid analgesia associated with shorter survival in adult patients with cancer? A systematic literature review. PAIN, 156 (11). 2152 - 2163. ISSN 0304-3959
Abstract
Opioids are important in the management of pain in patients with cancer. Clinicians and patients are sometimes concerned about the effect of opioids on survival, which might decrease opioid prescription, compliance and symptom control. We wanted to determine whether opioid analgesia was associated with shorter survival in adult patients with cancer. We systematically searched for studies that assessed the effect of regular systemic opioid analgesia on survival. We identified 526 unique records, with 20 articles meeting inclusion criteria. Thirteen end-of-life studies, including 11 very low quality retrospective studies, did not find a consistent association between opioid analgesic treatment and survival, this evidence comes from low quality studies, so should be interpreted with caution. Seven longer-term studies, including 3 randomised controlled trials and 2 prospective studies were included. Six of these studies indicated that opioids were likely to be associated with a shorter survival. None of these studies were powered to assess the effect of opioids on survival as a primary endpoint. In view of this, no definitive conclusions can be made as to whether opioids affect survival in cancer patients. These data suggest that while opioid analgesia does not affect survival at the end of life, in the context of longer-term treatment, higher quality studies, with survival as a primary endpoint, are needed to confirm an independent association between opioid analgesia and shorter survival. An important limitation of research in this field is that the relationship between greater analgesic requirements and shorter survival may be mediated by painful progressive cancer.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | (c) 2015 by the International Association for the Study of Pain. This is an author produced version of a paper published in PAIN. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | opioid, morphine, pain, cancer, survival, prognosis |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Health Economics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Primary Care (Leeds) |
Funding Information: | Funder Grant number National Inst for Health Research (NIHR) RP-DG-1108-10010 |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Dec 2015 16:13 |
Last Modified: | 16 Nov 2016 14:57 |
Published Version: | http://dx.doi.org/10.1097/j.pain.0000000000000306 |
Status: | Published |
Publisher: | Wolters Kluwer |
Identification Number: | 10.1097/j.pain.0000000000000306 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:88252 |