ArticleEuropean journal of clinical pharmacology2020
The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.
Article in European journal of clinical pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Palliative care utilisation globally by cancer patients: systematic review and meta-analysis.BMJ supportive & palliative care · 2025Pooled it
- Expert Consensus Develops Multidisciplinary Pathway for Cancer Pain Management in Italy: A Delphi Study.Current oncology (Toronto, Ont.) · 2026Article
- Cancer pain.Nature reviews. Disease primers · 2026Review
- Paracetamol and NSAIDs in Cancer Pain Management: Evidence Review and Treatment Considerations.Current treatment options in oncology · 2026Review
- Bridging Gaps in Cancer Pain Care: Barriers, Solutions, and a Path Forward for Integrated Management.Current oncology (Toronto, Ont.) · 2025Article
- The association between acupuncture and response to immune checkpoint inhibitors in non-small cell lung cancer.Chinese medicine · 2025Article
- Patient-reported pain severity is associated with shorter survival in older adults with newly diagnosed cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Are we doing enough to treat cancer pain? The urgent need for action in oncology practice.Future oncology (London, England) · 2025Article
- Relationship Between Spiritual Care Needs and Cognitive Intrusion of Pain in Patients with Advanced-Stage Cancer in Türkiye.Journal of religion and health · 2025Article
- Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model.Heliyon · 2024Article
- Management of pain in cancer patients - an update.Ecancermedicalscience · 2024Article
- Unraveling impact and potential mechanisms of baseline pain on efficacy of immunotherapy in lung cancer patients: a retrospective and bioinformatic analysis.Frontiers in immunology · 2024Article
- Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques.Current oncology (Toronto, Ont.) · 2023Review
- Effects of Opioids on Immune and Endocrine Function in Patients with Cancer Pain.Current treatment options in oncology · 2023Review
- Mapping the Evidence for Opioid-Mediated Changes in Malignancy and Chemotherapeutic Efficacy: Protocol for a Scoping Review.JMIR research protocols · 2023Article
- Long-term opioid therapy trajectories and overdose in patients with and without cancer.BMJ oncology · 2023Article
- Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits.Drugs in context · 2023Review
- Effect of Opioids on Survival in Patients with Cancer.Cancers · 2022Review
- Impact of opioid analgesics on the efficacy of immune checkpoint inhibitors in a lung cancer population.BMC pulmonary medicine · 2022Article
- Knowledge, attitudes, and practices toward cancer pain management amongst healthcare workers (physicians, pharmacists, and nurses): a cross-sectional study from first-tier cities in China.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
purposeOpioids reduce cancer-related pain but an association with shorter survival is variably reported.
aimTo investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making.
methodsSecondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death.
resultsDate of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6-49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 24% co-analgesics. Opioid-use was associated with decreased survival in the multivariable model (HR = 1.59 (95% CI:1.38-1.84), p < 0.001). An exploratory subgroup analysis of those with C-reactive protein (CRP) measures (n = 219) indicated higher CRP was associated with poorer survival (p = 0.001). In this model, the strength of relationship between survival and opioid-use weakened (p = 0.029).
conclusionOpioid-use and survival were associated; this relationship weakened in a small sensitivity-testing subgroup analysis adjusting for CRP. Thus, the observed relationship between survival and opioid-use may partly be due to tumour-related inflammation. Larger studies, measuring disease activity, are needed to confirm this finding to more accurately judge the benefits and risks of opioids in advanced progressive disease.
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