Patients who undergo lung cancer surgery and who receive long-term opioids for pain relief are at elevated risk of death, a new study suggests. The risk of all-cause mortality after 2 years was 40% higher than among patients who did not receive opioids.
"This is the first study to identify the association of new long-term opioid use with poorer long-term survival outcomes after lung cancer surgery using real-world data based on a national registration database," say the authors, led by In-Ae Song, MD, Seoul National University Bundang Hospital, Seongnam, Korea.
"New long-term opioid use may be associated with poor long-term survival outcomes, especially in potent opioid users," they conclude.
Long-term opioid use might promote protumor activity secondary to immunosuppression along with migration of tumor cells and angiogenesis, the authors suggest.
The finding comes from a study that used the South Korean National Health Insurance database as a nationwide registration data source. "All patients undergoing lung cancer surgery between 2011 and 2018 were included," the authors note.
In total, 54,509 patients were included in the final analysis. Six months after undergoing the procedure, 3325 patients (6.1%) had been prescribed opioids continuously and regularly. These patients constituted the new long-term opioid user group.
This finding fits in with those from past studies that have suggested that new long-term postoperative pain is reported in 4% to 12% of patients who undergo lung cancer surgeries, the authors comment.
The new study found that all-cause mortality at 2 years was significantly higher in the new long-term opioid user group than it was in the non-opioid user group (17.3% vs 9.3%; P < .001).
Moreover, the new long-term opioid user group were at 43% higher risk of 2-year lung cancer mortality and 29% higher risk of 2-year non–lung cancer mortality.
The investigators divided the patients who had received long-term opioids into two subgroups ― those who received more potent opioids (1.6%), and those who received less potent opioids (4.5%).
There was a big difference in the results for all-cause mortality.
Compared with non-opioid users, long-term use of less potent opioids was associated with a 2-year mortality risk of only 22% (P < .001), whereas the patients who used potent opioids were at 92% increased risk of all-cause mortality.
A number of risk factors were associated with an increased rate of new long-term opioid use. These included older age, being male, length of stay in hospital, and cormorbidities.
In addition, patients who were more likely to receive long-term opioids included those who had received neoadjuvant and adjuvant chemotherapy and those who had experienced preoperative anxiety disorder or insomnia disorder.
In contrast, patients who underwent video-assisted thoracoscopic surgery were less likely to receive long-term opioids, the authors note.
The authors have disclosed no relevant financial relationships.
Reg Anesth Pain Med. Published online August 4, 2022. Abstract
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