Abstract
Simple SummaryOpioids are one of the therapeutic and palliative options for breast cancer, a tumor with a strong epidemiological impact. Studies have been extensively reported in the literature that show a connection between the administration of opioids and the recurrence of the disease, both during surgery and subsequently in the management of cancer pain. This argument, in consideration of the strong impact of this cancer, is of great interest. Therefore, we decided, through the study of the existing literature, to describe the state of the art on this topic, to outline the best therapeutic approach to be adopted in these delicate patients.Breast cancer has the greatest epidemiological impact in women. Opioids represent the most prescribed analgesics, both in surgical time and in immediate postoperative period, as well as in chronic pain management as palliative care. We made a systematic review analyzing the literature’s evidence about the safety of opioids in breast cancer treatment, focusing our attention on the link between opioid administration and increased relapses. The research has been conducted using the PubMed database. Preclinical studies, retrospective and prospective clinical studies, review articles and original articles were analyzed. In the literature, there are several preclinical in vitro and in vivo studies, suggesting a possible linkage between opioids administration and progression of cancer disease. Nevertheless, these results are not confirmed by clinical studies. The most recent evidence reassures the safety of opioids during surgical time as analgesic associated with anesthetics drugs, during postoperative period for optimal cancer-related pain management and in chronic use. Currently, there is controversial evidence suggesting a possible impact of opioids on breast cancer progression, but to date, it remains an unresolved issue. Although there is no conclusive evidence, we hope to arouse interest in the scientific community to always ensure the best standards of care for these patients.
Highlights
Breast cancer has the greatest epidemiological impact in women, affecting 2.1 million women each year, and it is responsible for the major cancer-related deaths among women.In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally, meaning approximately 15% of all female cancer deaths [1]
Analgesia may interfere with immune system and cancer progression both directly, intervening in cellular mechanisms such as apoptosis, or indirectly by acting on neuroendocrine and sympathetic systems: it has been demonstrated that there was a reduction of pulmonary metastases after surgery in animal models treated with morphine-based analgesia [35,36]. These results indicate that the choice of anesthetic technique seems to have profound implications on the cytokine background and immune microenvironment in breast cancer surgery, and that this may influence cancer recurrence and metastasis [3]
The beneficial results deriving from the opioids use in cancer patients consist of an improvement in quality of life, a reduction in neuroendocrine stress responses and in emotional stress, which in turn provides a better compliance with cancer treatments, all resulting in a positive influence on survival
Summary
Breast cancer has the greatest epidemiological impact in women, affecting 2.1 million women each year, and it is responsible for the major cancer-related deaths among women.In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally, meaning approximately 15% of all female cancer deaths [1]. For the treatment of breast cancer, the crucial therapeutic moment is the surgery time, despite the several therapeutic options available to date. The perioperative period includes three moments: a pre-operative period corresponding to a few preoperative hours, an intraoperative period and a postoperative period consisting of several days after surgical treatment [3]. Three surgical factors favor the process of initiation and progression of residual tumoral cells: firstly, surgery itself, because the surgical manipulation may inadvertently scatter residual cancer cells into the bloodstream and lymphatic circulation [3,4] and determines a state of immunosuppression by depressing cell-mediated immunity (CMI). There is evidence in the literature that the use of opioid analgesics could inhibit immune function, angiogenesis, and tumor growth [7]
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