Boland Jason W, Ziegler Lucy, Boland Elaine G, McDermid Kirstine, Bennett Michael I
Hull York Medical School, University of Hull, Hull, United Kingdom Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom Hull and East Yorkshire Hospitals NHS Trust, Cottingham, United Kingdom Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom.
Pain. 2015 Nov;156(11):2152-2163. doi: 10.1097/j.pain.0000000000000306.
Opioids are important in the management of pain in patients with cancer. Clinicians and patients are sometimes concerned about the effect of opioids on survival, which might decrease opioid prescription, compliance, and symptom control. We wanted to determine whether opioid analgesia was associated with shorter survival in adult patients with cancer. We systematically searched for studies that assessed the effect of regular systemic opioid analgesia on survival. We identified 526 unique records, with 20 articles meeting inclusion criteria. Thirteen end-of-life studies, including 11 very low-quality retrospective studies, did not find a consistent association between opioid analgesic treatment and survival; this evidence comes from low-quality studies, so should be interpreted with caution. Seven longer-term studies, including three randomised controlled trials and two prospective studies, were included. Six of these studies indicated that opioids were likely to be associated with a shorter survival. None of these studies were powered to assess the effect of opioids on survival as a primary endpoint. In view of this, no definitive conclusions can be made as to whether opioids affect survival in patients with cancer. These data suggest that while opioid analgesia does not affect survival at the end of life, in the context of longer-term treatment, higher-quality studies, with survival as a primary endpoint, are needed to confirm an independent association between opioid analgesia and shorter survival. An important limitation of research in this field is that the relationship between greater analgesic requirements and shorter survival may be mediated by painful progressive cancer.
阿片类药物在癌症患者疼痛管理中至关重要。临床医生和患者有时会担心阿片类药物对生存的影响，这可能会减少阿片类药物的处方、依从性以及症状控制。我们想确定阿片类镇痛是否与成年癌症患者较短的生存期相关。我们系统地检索了评估常规全身性阿片类镇痛对生存影响的研究。我们识别出526条独特记录，其中20篇文章符合纳入标准。13项临终研究，包括11项质量极低的回顾性研究，未发现阿片类镇痛治疗与生存之间存在一致关联；该证据来自低质量研究，因此应谨慎解读。纳入了7项长期研究，包括3项随机对照试验和2项前瞻性研究。其中6项研究表明阿片类药物可能与较短生存期相关。这些研究均未设定将评估阿片类药物对生存的影响作为主要终点。鉴于此，关于阿片类药物是否影响癌症患者的生存，无法得出明确结论。这些数据表明，虽然阿片类镇痛在临终时不影响生存，但在长期治疗的背景下，需要以生存作为主要终点的更高质量研究来证实阿片类镇痛与较短生存期之间的独立关联。该领域研究的一个重要局限性在于，更大镇痛需求与较短生存期之间的关系可能由疼痛性进展期癌症介导。
