Total pain, opioids, and immune checkpoint inhibitors in the survival of patients with cancer

IF 7.1 2区 医学 Q1 ONCOLOGY
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Abstract

Experimental and observational studies have shown that opioid analgesics may increase tumor growth, potentially reduce immunotherapy efficacy, and shorten survival. As a result of the lack of clinical data, the current rationale for continuing opioid analgesic treatment is based on animal models, which suggests that physical pain itself may potentially influence cancer growth and exert immunosuppressive effects. Total pain encompasses the various factors that patients may experience during their cancer journey: physical symptoms, social isolation/loneliness, psychological, spiritual/existential, and financial distress. These need to be screened and discussed with patients to help them cope with the treatment and disease. As each issue may affect survival, it is essential to identify them to understand how they might affect the patient’s immune system, influence immunotherapy outcomes, and ultimately, survival. The question arises whether a single factor, such as the combination of opioids and immune checkpoint inhibitors, negatively affects treatment outcomes. While there is a risk of fostering opioid phobia, the complex interplay between total pain, quality of life, and the immune system must be considered. Thus, in studies that appropriately investigate the interactions between opioid analgesics and the immune system, it is essential to consider all the distress factors that patients may experience at each stage of their illness.

癌症患者生存过程中的总疼痛、阿片类药物和免疫检查点抑制剂
实验和观察性研究表明,阿片类镇痛药可能会增加肿瘤生长,可能会降低免疫疗法的疗效,缩短生存期。由于缺乏临床数据,目前继续使用阿片类镇痛药治疗的依据是动物模型,这表明身体疼痛本身可能会影响癌症生长并产生免疫抑制作用。总体疼痛包括患者在癌症治疗过程中可能经历的各种因素:身体症状、社会隔离/孤独感、心理、精神/存在感和经济困扰。需要对这些因素进行筛查并与患者进行讨论,以帮助他们应对治疗和疾病。由于每个问题都可能影响患者的存活,因此有必要找出这些问题,以了解它们可能如何影响患者的免疫系统、影响免疫疗法的效果以及最终影响患者的存活。问题在于,单一因素(如阿片类药物和免疫检查点抑制剂的组合)是否会对治疗结果产生负面影响。虽然存在助长阿片类药物恐惧症的风险,但必须考虑到总体疼痛、生活质量和免疫系统之间复杂的相互作用。因此,在对阿片类镇痛药与免疫系统之间的相互作用进行适当调查的研究中,必须考虑患者在疾病的各个阶段可能经历的所有痛苦因素。
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来源期刊
ESMO Open
ESMO Open Medicine-Oncology
CiteScore
11.70
自引率
2.70%
发文量
255
审稿时长
10 weeks
期刊介绍: ESMO Open is the online-only, open access journal of the European Society for Medical Oncology (ESMO). It is a peer-reviewed publication dedicated to sharing high-quality medical research and educational materials from various fields of oncology. The journal specifically focuses on showcasing innovative clinical and translational cancer research. ESMO Open aims to publish a wide range of research articles covering all aspects of oncology, including experimental studies, translational research, diagnostic advancements, and therapeutic approaches. The content of the journal includes original research articles, insightful reviews, thought-provoking editorials, and correspondence. Moreover, the journal warmly welcomes the submission of phase I trials and meta-analyses. It also showcases reviews from significant ESMO conferences and meetings, as well as publishes important position statements on behalf of ESMO. Overall, ESMO Open offers a platform for scientists, clinicians, and researchers in the field of oncology to share their valuable insights and contribute to advancing the understanding and treatment of cancer. The journal serves as a source of up-to-date information and fosters collaboration within the oncology community.
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