Correlation Between the Administration of Morphine or Oxycodone and the Development of Infections in Patients With Cancer Pain

Abstract

Morphine and oxycodone are widely used in the therapy for cancer pain. Although some previous studies have reported that morphine induces immunosuppression and oxycodone does not, whether this is true for human infections is unclear. We performed a retrospective study on the correlation between the administration of morphine or oxycodone and the development of infections in patients with cancer pain. This study was undertaken in 841 inpatients receiving only 1 opioid continuously for more than 10 days. Development of infections was based on (1) antibiotic administration and (2) diagnosis of infections, positive microbial culture test, or increase in white blood cells or C-reactive protein. Liver, kidney, and hematological cancer, antineoplastic drugs, radiotherapy, steroid, immunosuppressive agents, granulocyte colony-stimulating factor, and thyroid inhibitors were defined as the exclusion criteria in consideration of influence on immune system or metabolism and excretion of morphine and oxycodone. A total of 60 morphine and 74 oxycodone cases were included, which resulted in 18 and 10 infection cases. Significantly more patients treated with morphine developed infections than those patients treated with oxycodone (odds ratio = 3.60, 95% confidence interval = 1.40-9.26). No significant differences were seen in the other variables analyzed. Although perhaps some confounding variables were included because this was an observational rather than randomized study, these results suggested that morphine's immunosuppressive effect may contribute to the development of infections in patients with cancer pain.