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Long-term opioid use is more common in patients treated with invasive surgical techniques for early-stage non-small-cell lung cancer than in those with minimally invasive surgery.
Mount Sinai researchers in New York examined 3,900 patients with stage 1 disease who underwent video-assisted thoracoscopic surgery (1,987 patients) or traditional open surgery (1,913 patients).
"The traditional approach is open thoracotomy," said Emanuela Taioli, MD, Ph.D., director of the Institute for Translational Epidemiology and Professor of Thoracic Surgery and Science and Policy of the population health at the Icahn School of Medicine at Mount Sinai. "Some surgeons learn to practice a less invasive procedure – video-assisted thoracoscopic surgery – which consists of a small cut between the ribs, and then (the surgeon) uses specific equipment to extract the tumor and lung needed. . "
However, the procedure has two obstacles: cost and training. The equipment is expensive and must be available at the hospital, Taioli said, and surgeons need to know how to perform video-assisted thoracoscopic surgery.
In the study, the researchers speculated that the more invasive surgery is, the more opioids the patient needs at higher doses, which is more likely to become a chronic habit.
Opioid consumption was examined one month before surgery and no patient had a history. At discharge, 70.9% (2,766 patients) received an opioid prescription for postoperative pain relief. The study results showed that 15.5% (603 patients) became chronic users of opioids six months after surgery.
"These were new people who had been exposed to opioids to control their pain," Taioli said.
"Even though it's chronic pain, opioids are not supposed to be used as a treatment. Opioids should be used for acute relief of pain after surgery. "
Chronic use was more likely if patients had a higher comorbidity score, took sleeping pills 30 days before surgery, and already had a psychiatric condition. Patients were significantly less likely to perform opioid prescriptions immediately after surgery and long-term patients undergoing video-assisted thoracoscopic surgery, were older, and had higher income.
To help alleviate the problem, doctors should try to use the least invasive surgery possible, Taioli recommended. "There is still a lot of debate about the use of less invasive surgery," she said. "Not all surgeons are convinced that the results are the same in terms of cancer control, but if we add the information that a less invasive surgery may also be less of a chance to become a chronic user of cancer." 39, opioids, I think it's a good piece of information when someone has to decide which way to go. "
Communication should also be part of the follow-up – not only for doctors but also for patients. "Patients should make sure to talk to their doctor about the pain and side effects of surgery," Taioli said. "Some patients think that this is not important information, that the doctor is primarily interested in the tumor and the treatment, but it is also important."
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