Evidence map›Paper›PMID 27744535›Full record

SynthesisSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2017

The use of opioids in cancer patients with renal impairment-a systematic review.

Tonje A Sande, Barry J A Laird, Marie T Fallon

Open access · greenAbstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
5.8field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Identifying risk factors for opioid-induced neurotoxicity in cancer patients receiving oxycodone.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023
    Article
  6. Consensus document on palliative care in cardiorenal patients.Frontiers in cardiovascular medicine · 2023
    Review
  7. Review
  8. Review
  9. Article
  10. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2020
    Review
  11. Review
  12. Review
  13. Review
  14. Review
  15. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Tonje A SandeInstitute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. tonjesande@gmail.com.
Barry J A LairdInstitute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
Marie T FallonInstitute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
MRC Institute of Genetics and Molecular Medicine · GBUniversity of Edinburgh · GB

Funding

Marie Curie MCCC-RP-15-A18862
6 · The paper itself

Abstract

purposeOpioids are recommended for moderate to severe cancer pain; however, in patients with cancer, impaired renal function can affect opioid metabolism. The aim of this systematic review was to evaluate the current evidence for the use of opioids in cancer patients with renal impairment.

methodsA systematic review was conducted and the following databases were searched: MEDLINE (1966 to 2015), EMBASE (1980 2015) and Cochrane Central Register of Controlled Trials (up to 2015). Eligible studies met the following criteria: patients with cancer pain taking an opioid (defined as per the WHO ladder); >18 years; renal impairment (serum creatinine > normal range (study dependent), creatinine clearance (CrCl) or glomerular filtration rate (GFR) measurements <90 ml/min, or as per the study definition); clinical outcome related to renal impairment. All eligible studies were appraised using the Grading of Recommendation Assessment, Development and Evaluations (GRADE) system.

resultsEighteen studies (n = 2422) were eligible but heterogeneity meant meta-analysis was not possible. Morphine was examined in eight studies (n = 1418), oxycodone in two studies (n = 325), and fentanyl, alfentanil or sufentanil were discussed in six studies in total (n = 442). No recommendations could be formulated on the preferred opioid in patients with renal impairment.

conclusionThere is lack of consensus within the existing literature on the relationship between morphine, creatinine levels and morphine-related side effects. Based on the current evidence, morphine should be used with caution; however, more evidence is needed. Fentanyl, alfentanil and sufentanil are recommended in patients with renal impairment based on pharmacokinetics and clinical experience. However, the present systematic review found very little clinical evidence for this. Overall, the quality of the existing evidence on opioid treatment in cancer patients with renal impairment is low. There remains a need for high-quality clinical studies examining opioids in patients with renal impairment.

Indexed as

Analgesics, OpioidDrug-Related Side Effects and Adverse ReactionsFentanylHumansNeoplasmsPainRenal InsufficiencyAnalgesics, OpioidFentanylCancerOpioidsPainRenal impairment

Identifiers

PMID27744535
OpenAlexW2530918212

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.