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Editorial
State of the science: opioids and survival in cancer pain management
  1. Jason W Boland1,2 and
  2. Michael I Bennett3
  1. 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  2. 2 Care Plus Group and St Andrew’s Hospice, NE Lincolnshire, UK
  3. 3 Academic Unit of Palliative Care, University of Leeds, Leeds, UK
  1. Correspondence to Dr Jason W Boland, Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine, Hull York Medical School, Hull HU6 7RX, UK; Jason.Boland{at}hyms.ac.uk

https://doi.org/10.1136/bmjspcare-2020-002624

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    Introduction

    Opioids are commonly used for cancer-related pain in advanced disease and about 75% of people have a good response. However, undertreatment is common, and opioids are often started only weeks before death. Undertreated pain might decrease survival in some, although prospective studies to delineate how pain and opioids affect cancer progression and survival in various malignancies are absent.1 One systematic review found that most (11 of 17) studies in advanced prostate cancer showed pain to be an independent prognostic factor for shorter survival.1 However, five studies defined pain by analgesic use, making it difficult to determine if pain or opioid use was more important. In breast, colorectal or lung cancer evidence was insufficient to definitively determine if pain independently influences survival.1 In a secondary data analysis, recurrent ovarian cancer pain was an independent marker for shorter overall survival.2 In this study, survival was shorter in those with pain and without pain medication compared with those on sufficient pain medication.2

    Long-term opioid adverse effects

    Clinicians and patients are understandably concerned, respectively, about prescribing and taking opioids. These concerns include side effects, addiction and the perception that opioid use indicates the end of …

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    Footnotes

    • Contributors JWB conceptualised and drafted the manuscript. JWB and MIB edited the manuscript and approved it for submission. JWB is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.