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Lung cancer patients who begin to use opioids following surgery are at increased risk of death from any cause within the next two years, according to new research.
While the overall risk of death increased by 40% compared to those not taking opioids, participants taking more potent forms of the drug (such as fentanyl, morphine, oxycodone, hydromorphone and methadone) were 92% more likely to die.
The authors of the study, which is published in the journal Regional Anaesthesia & Pain Medicine, say further research will now need to be conducted to confirm the findings.
More than 50,000 participants were included in the study
The study included all adults diagnosed with lung cancer, and who had undergone surgery for their disease between 2011 and 2018 in South Korea, details of which were retrieved from the National Health Insurance Service (NHIS) database.
Some 60,031 adults underwent lung cancer surgery during the study period, and after excluding those who died in hospital or within the first six months of discharge, the final analysis included 54,509 participants.
Six months after surgery, around 6% (3,325 patients) who had been newly prescribed opioids were still taking them. Opioid usage was categorised into two groups: less potent opioids (codeine, dihydrocodeine, and tramadol) and more potent opioids (fentanyl, morphine, oxycodone, hydromorphone and methadone).
Older men more likely to become new, long-term opioid users
After accounting for confounding variables (including underlying conditions/disabilities, surgery type and whether it was a repeat or first-time procedure), the researchers found that new long-term opioid use was associated with a heightened risk of death from any cause within the next two years.
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.
Certain factors were associated with a greater likelihood of becoming a new long-term user including older age, male sex, particular surgical procedures (especially thoracotomy where a cut is made between the ribs) longer length of hospital stay, a greater degree of disability, chemotherapy treatment, and preoperative anxiety and insomnia.
Opioids may help promote tumour growth and inhibit cancer cell death
While the study can’t establish a cause, the researchers say their findings seem to substantiate claims that opioids may help promote tumour growth and inhibit cancer cell death, while also suppressing the immune system.
They conclude: “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.”
Further research will now need to be conducted to confirm the findings, they note.
