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Effects of opioids on immunologic parameters that are relevant to anti-tumour immune potential in patients with cancer: a systematic literature review.

Boland JW, McWilliams K, Ahmedzai SH, Pockley AG - Br. J. Cancer (2014)

Bottom Line: Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these tumour immune surveillance mechanisms.Evidence from preclinical, healthy volunteer and surgical models suggests that different opioids variably influence protective anti-tumour immunity; however, actual data derived from cancer populations are inconclusive and definitive recommendations cannot be made.Appropriately designed and powered studies assessing clinical outcomes of opioid use in people with cancer are therefore required to inform oncologists and others involved in cancer care about the rational use of opioids in this patient group.

View Article: PubMed Central - PubMed

Affiliation: Hull York Medical School, University of Hull, Hull HU6 7RX, UK.

ABSTRACT

Background: The immune system has a central role in controlling cancer, and factors that influence protective antitumour immunity could therefore have a significant impact on the course of malignant disease. Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these tumour immune surveillance mechanisms. The aim of this systematic literature review is to evaluate the clinical effects of opioids on the immune system of patients with cancer.

Methods: A systematic search of Ovid MEDLINE (PubMed) and Embase, Cochrane database and Web of Knowledge for clinical studies, which evaluated the effects of opioids on the immune system in patients with cancer, was performed.

Results: Five human studies, which have assessed the effects of opioids on the immune system in patients with cancer, were identified. Although all of these evaluated the effect of morphine on immunologic end points in patients with cancer, none measured the clinical effects.

Conclusions: Evidence from preclinical, healthy volunteer and surgical models suggests that different opioids variably influence protective anti-tumour immunity; however, actual data derived from cancer populations are inconclusive and definitive recommendations cannot be made. Appropriately designed and powered studies assessing clinical outcomes of opioid use in people with cancer are therefore required to inform oncologists and others involved in cancer care about the rational use of opioids in this patient group.

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Related in: MedlinePlus

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Mentions: The aim of this review was to identify all relevant non-surgical clinical studies that have evaluated the effects of opioids on the immune system in patients with cancer. On 8 November 2013, the electronic databases Ovid MEDLINE (PubMed) and Embase (Ovid MEDLINE(R) 1946 to Present and Ovid MEDLINE In-Process and Other Non-Indexed Citations, and Embase 1974 to 2013 Week 29), Cochrane database and Web of Knowledge were searched using the terms and dates listed below. These were devised to be inclusive of all potentially relevant studies and have been extended to include terms relating to other conditions that are mapped to Medical Subject Heading (MeSH) terms as well as searching for these terms as text word searches to increase the search sensitivity. To search for opioids, the search terms used were: opioid OR opiate OR morphine OR codeine OR buprenorphine OR methadone OR tramadol OR tapentadol OR oxycodone OR heroin OR fentanyl OR hydromorphone OR oxymorphone. These were combined with a search for cancer OR neoplasm and immunity: including immune* OR NK cell OR T cell. The limits were English language; clinical trial (any); adults; humans; all adult (MEDLINE) from 1974 to 2013. All titles and abstracts were reviewed to assess their relevance for inclusion. The results of these searches are shown in the PRISMA Flow Diagram (Figure 1; Moher et al, 2009).


Effects of opioids on immunologic parameters that are relevant to anti-tumour immune potential in patients with cancer: a systematic literature review.

Boland JW, McWilliams K, Ahmedzai SH, Pockley AG - Br. J. Cancer (2014)

PRISMA flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150281&req=5

fig1: PRISMA flow diagram.
Mentions: The aim of this review was to identify all relevant non-surgical clinical studies that have evaluated the effects of opioids on the immune system in patients with cancer. On 8 November 2013, the electronic databases Ovid MEDLINE (PubMed) and Embase (Ovid MEDLINE(R) 1946 to Present and Ovid MEDLINE In-Process and Other Non-Indexed Citations, and Embase 1974 to 2013 Week 29), Cochrane database and Web of Knowledge were searched using the terms and dates listed below. These were devised to be inclusive of all potentially relevant studies and have been extended to include terms relating to other conditions that are mapped to Medical Subject Heading (MeSH) terms as well as searching for these terms as text word searches to increase the search sensitivity. To search for opioids, the search terms used were: opioid OR opiate OR morphine OR codeine OR buprenorphine OR methadone OR tramadol OR tapentadol OR oxycodone OR heroin OR fentanyl OR hydromorphone OR oxymorphone. These were combined with a search for cancer OR neoplasm and immunity: including immune* OR NK cell OR T cell. The limits were English language; clinical trial (any); adults; humans; all adult (MEDLINE) from 1974 to 2013. All titles and abstracts were reviewed to assess their relevance for inclusion. The results of these searches are shown in the PRISMA Flow Diagram (Figure 1; Moher et al, 2009).

Bottom Line: Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these tumour immune surveillance mechanisms.Evidence from preclinical, healthy volunteer and surgical models suggests that different opioids variably influence protective anti-tumour immunity; however, actual data derived from cancer populations are inconclusive and definitive recommendations cannot be made.Appropriately designed and powered studies assessing clinical outcomes of opioid use in people with cancer are therefore required to inform oncologists and others involved in cancer care about the rational use of opioids in this patient group.

View Article: PubMed Central - PubMed

Affiliation: Hull York Medical School, University of Hull, Hull HU6 7RX, UK.

ABSTRACT

Background: The immune system has a central role in controlling cancer, and factors that influence protective antitumour immunity could therefore have a significant impact on the course of malignant disease. Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these tumour immune surveillance mechanisms. The aim of this systematic literature review is to evaluate the clinical effects of opioids on the immune system of patients with cancer.

Methods: A systematic search of Ovid MEDLINE (PubMed) and Embase, Cochrane database and Web of Knowledge for clinical studies, which evaluated the effects of opioids on the immune system in patients with cancer, was performed.

Results: Five human studies, which have assessed the effects of opioids on the immune system in patients with cancer, were identified. Although all of these evaluated the effect of morphine on immunologic end points in patients with cancer, none measured the clinical effects.

Conclusions: Evidence from preclinical, healthy volunteer and surgical models suggests that different opioids variably influence protective anti-tumour immunity; however, actual data derived from cancer populations are inconclusive and definitive recommendations cannot be made. Appropriately designed and powered studies assessing clinical outcomes of opioid use in people with cancer are therefore required to inform oncologists and others involved in cancer care about the rational use of opioids in this patient group.

Show MeSH
Related in: MedlinePlus