Researchers find opioid use after lung cancer surgery have association with risk of death

Long-term opioid usage for pain relief after lung cancer surgery is linked to a 40% higher risk of mortality from any cause during the next two years.

The research findings were published online in the journal Regional Anesthesia & Pain Medicine. The data suggest that male sex, older age, chemo usage, anxiety, and sleeplessness are among the characteristics related with new long-term (6 or more months) use.

With roughly 2.3 million diagnoses and 1.8 million deaths in 2020, lung cancer is the leading cause of cancer mortality globally. In addition, up to 12% of patients have experienced new chronic postoperative pain.

The researchers sought to discover how many of them became opioid users for the first time after surgery, if certain variables are connected with long-term use, and if this is associated with any negative effects in the next two years.

They comprised all persons diagnosed with lung cancer and who underwent surgery for their ailment in South Korea between 2011 and 2018, according to data from the National Health Insurance Service (NHIS).

Doctors in South Korea must submit information on their patients’ diagnoses, treatments, and prescription medicines in order for the government to compensate them for treatment costs. The database also includes background personal information about each registrant, such as age, gender, and household income, as well as the date of death.

Codeine, dihydrocodeine, and tramadol were classified as less potent opioids, whereas fentanyl, morphine, oxycodone, hydromorphone, and methadone were classified as strong opioids.

Other underlying conditions/disabilities were considered, as well as the type of surgery and whether it was a repeat or first-time treatment, where it was conducted, and if the patient was released 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 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 per cent) who had been newly prescribed opioids were still taking them: 859 (1.6 per cent) were on potent drugs and 2466 (4.5 per cent) were on less potent drugs.

New long-term opioid use was associated with a heightened risk of death from any cause within the next 2 years; 17.5 per cent (574/3325) of long term opioid users died compared with 9.5 per cent (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 per cent more likely to die; those taking more potent opioids were 92 per cent more likely to die.

Certain factors were associated with a greater likelihood of becoming a new long term user: 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.

This is an observational study, and as such, can’t establish cause. And the researcher’s highlight that they weren’t able to ascertain lung health before surgery, important lifestyle behaviours, such as smoking and drinking, or tumour stage, all of which may have influenced the findings.

However, past research suggests that opioids may accelerate tumour development and decrease cancer cell death, while also inhibiting the immune system.