Long-term opioid use after lung cancer surgery linked to 40% higher death risk within next 2 years

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In a study from Thomas Jefferson University, scientists found new long-term use of opioids to quell pain after lung cancer surgery is linked to a 40% heightened risk of death from any cause within the next 2 years.

Male sex, older age, use of chemo, anxiety, and insomnia are among the factors associated with new long-term (6 or more months) use.

Lung cancer is the leading cause of cancer death worldwide, with nearly 2.3 million diagnoses and 1.8 million deaths in 2020. New persistent postoperative pain has been reported in up to 12% of patients.

In the study, researchers examined adults diagnosed with lung cancer and who had undergone surgery for their disease between 2011 and 2018 in South Korea.

Doctors in South Korea must enter details of their patients’ diagnoses, procedures, and prescription drugs in order to be reimbursed for treatment costs by the government.

The database also contains background personal information, including the age, sex, and household income of every registrant and the date of their death.

Codeine, dihydrocodeine, and tramadol were categorized as less potent opioids; all other opioids, such as fentanyl, morphine, oxycodone, hydromorphone and methadone, were categorized as potent opioids.

The researchers took account of other underlying conditions/disabilities, surgery type and whether it was a repeat or first-time procedure, where it was performed, and whether the patient was discharged home or to long-term care.

Some 60,031 adults underwent lung cancer surgery during the study period, and after excluding those who died in the hospital or within the first 6 months of discharge, the final analysis included 54,509 of them.

Six months after surgery, 3325 patients (just over 6%) who had recently been prescribed opioids were still taking them: 859 (1.6%) were on potent drugs and 2466 (4.5%) were on less potent drugs.

New long-term opioid use was linked to a higher risk of death from any cause within the next 2 years; 17.5% (574/3325) of long-term opioid users died compared with 9.5% (4738/51,184) of those not taking opioids.

Compared with those not taking opioids, new long-term users of these drugs were 40% more likely to die within the next 2 years of any cause.

When stratified by potency, those taking less potent opioids were still 22% more likely to die; those taking more potent opioids were 92% more likely to die.

The team found certain factors were associated with a greater likelihood of becoming a new long-term user:

older age, male sex, particularly surgical procedures, especially thoracotomy where a cut was made between the ribs, the longer length of hospital stay, a greater degree of disability, chemotherapy treatment, and preoperative anxiety and insomnia.

The team suggests that opioids may help promote tumor growth and inhibit cancer cell death, while also suppressing the immune system.

If you care about pain, please read studies about why long COVID can cause pain, and common native American plant may help reduce diarrhea and pain.

For more information about pain, please see recent studies about why people with red hair respond differently to pain than others, and results showing this drug may relieve painful ‘long covid’ symptoms.

The study was conducted by Eric Schwenk et al and published in Regional Anesthesia & Pain Medicine.

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