Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases
Introduction: Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor...
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| Format: | Article |
| Language: | English |
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The Japanese Society for Spine Surgery and Related Research
2023-05-01
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| Series: | Spine Surgery and Related Research |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/7/3/7_2021-0169/_pdf/-char/en |
| _version_ | 1797804045071548416 |
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| author | Sho Dohzono Ryuichi Sasaoka Kiyohito Takamatsu Hiroaki Nakamura |
| author_facet | Sho Dohzono Ryuichi Sasaoka Kiyohito Takamatsu Hiroaki Nakamura |
| author_sort | Sho Dohzono |
| collection | DOAJ |
| description | Introduction: Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor-related spinal instability.
Methods: We retrospectively identified 428 patients who had been diagnosed with spinal metastases from February 2009 to May 2017. Those with an opioid prescription during the first 1 month after the diagnosis were included in this study. Patients given opioids were divided into two groups: the opioid requirement group [5 mg oral morphine equivalent (OME)/day] and the nonopioid group (<5 mg OME/day). Spinal instability due to metastases was evaluated using the Spinal Instability Neoplastic Score (SINS). Cox proportional hazards analysis was performed to evaluate the relationship between opioid use and overall survival.
Results: The most frequent primary cancer site was the lung, in 159 patients (37%), followed by the breast in 75 (18%) and the prostate in 46 (11%). Multivariate analyses showed that patients who required 5 mg OME/day were approximately twofold more likely to die after a spinal metastases diagnosis than those who required <5 mg OME/day (hazard ratio 2.13; 95% confidence interval 1.69-2.67; p<0.001). The SINS was significantly higher in the opioid requirement group than those in the nonopioid group (p<0.001).
Conclusions: For patients with spinal metastases, opioid requirement was associated with shorter survival, independently of known prognostic factors. The patients were also more likely to have tumor-related spinal instability than those in the nonopioid group. |
| first_indexed | 2024-03-13T05:30:15Z |
| format | Article |
| id | doaj.art-3098e6e6bb344795b7eb9471571ddff6 |
| institution | Directory Open Access Journal |
| issn | 2432-261X |
| language | English |
| last_indexed | 2024-03-13T05:30:15Z |
| publishDate | 2023-05-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj.art-3098e6e6bb344795b7eb9471571ddff62023-06-15T01:33:21ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2023-05-017323524110.22603/ssrr.2021-01692021-0169Association between Opioid Requirement and Overall Survival in Patients with Spinal MetastasesSho Dohzono0Ryuichi Sasaoka1Kiyohito Takamatsu2Hiroaki Nakamura3Department of Orthopaedic Surgery, Yodogawa Christian HospitalDepartment of Orthopaedic Surgery, Yodogawa Christian HospitalDepartment of Orthopaedic Surgery, Yodogawa Christian HospitalDepartment of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of MedicineIntroduction: Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor-related spinal instability. Methods: We retrospectively identified 428 patients who had been diagnosed with spinal metastases from February 2009 to May 2017. Those with an opioid prescription during the first 1 month after the diagnosis were included in this study. Patients given opioids were divided into two groups: the opioid requirement group [5 mg oral morphine equivalent (OME)/day] and the nonopioid group (<5 mg OME/day). Spinal instability due to metastases was evaluated using the Spinal Instability Neoplastic Score (SINS). Cox proportional hazards analysis was performed to evaluate the relationship between opioid use and overall survival. Results: The most frequent primary cancer site was the lung, in 159 patients (37%), followed by the breast in 75 (18%) and the prostate in 46 (11%). Multivariate analyses showed that patients who required 5 mg OME/day were approximately twofold more likely to die after a spinal metastases diagnosis than those who required <5 mg OME/day (hazard ratio 2.13; 95% confidence interval 1.69-2.67; p<0.001). The SINS was significantly higher in the opioid requirement group than those in the nonopioid group (p<0.001). Conclusions: For patients with spinal metastases, opioid requirement was associated with shorter survival, independently of known prognostic factors. The patients were also more likely to have tumor-related spinal instability than those in the nonopioid group.https://www.jstage.jst.go.jp/article/ssrr/7/3/7_2021-0169/_pdf/-char/encancerspinal metastasesprognosisopioidspinal instability |
| spellingShingle | Sho Dohzono Ryuichi Sasaoka Kiyohito Takamatsu Hiroaki Nakamura Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases Spine Surgery and Related Research cancer spinal metastases prognosis opioid spinal instability |
| title | Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases |
| title_full | Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases |
| title_fullStr | Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases |
| title_full_unstemmed | Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases |
| title_short | Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases |
| title_sort | association between opioid requirement and overall survival in patients with spinal metastases |
| topic | cancer spinal metastases prognosis opioid spinal instability |
| url | https://www.jstage.jst.go.jp/article/ssrr/7/3/7_2021-0169/_pdf/-char/en |
| work_keys_str_mv | AT shodohzono associationbetweenopioidrequirementandoverallsurvivalinpatientswithspinalmetastases AT ryuichisasaoka associationbetweenopioidrequirementandoverallsurvivalinpatientswithspinalmetastases AT kiyohitotakamatsu associationbetweenopioidrequirementandoverallsurvivalinpatientswithspinalmetastases AT hiroakinakamura associationbetweenopioidrequirementandoverallsurvivalinpatientswithspinalmetastases |