Perioperative Immunosuppression and Risk of Cancer Progression: The Impact of Opioids on Pain Management

Opioids comprise an important group of drugs used in cancer pain pharmacotherapy. In recent years, more and more studies have emerged indicating the potentially immunosuppressive effects of opioid analgesics and their serious consequences, including the risk of cancer progression. The identification of these risks has prompted a search for other effective, and most importantly, safer methods of perioperative analgesic management. Regional analgesia techniques, which allow for a significant reduction in opioid dosing and thus diminish the risk of immunosuppression associated with these drugs, seem to offer substantial hope in this respect. A number of studies available in the literature assess the effects of regional analgesia techniques on cancer progression; however, it is often difficult to interpret their results owing to several perioperative factors (such as surgical trauma, inadequate pain and stress relief, and hypothermia) which are also attributed immunosuppressive effects and tend to be implicated in increased risk of cancer progression. Further research is needed to verify the available data on both the potential adverse effects of opioids and the possible protective effects of regional analgesia techniques on cancer patients.

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Anti-seizure medication is not associated with an increased risk to develop cancer in epilepsy patients

Journal of Neurology ◽

10.1007/s00415-020-10379-4 ◽

2021 ◽

Author(s):

Jenny Stritzelberger ◽

Johannes D. Lang ◽

Tamara M. Mueller ◽

Caroline Reindl ◽

Vivien Westermayer ◽

...

Keyword(s):

Cancer Risk ◽

Cancer Diagnosis ◽

Index Date ◽

Control Group ◽

Protective Effects ◽

Promoting Effect ◽

Increased Risk ◽

Comorbidity Index ◽

Preclinical And Clinical Studies ◽

Risk Of Cancer

Abstract Objective Whether anti-seizure medication (ASM) increases the risk for cancer has been debated for decades. While for some ASM, a carcinoma-promoting effect has been suspected, carcinoma-protective effects have been shown for other ASM. However, the issue remains unresolved as data from preclinical and clinical studies have been inconsistent and contradictory. Methods We collected anonymous patient data from practice neurologists throughout Germany between 2009 and 2018 using the IMS Disease Analyzer database (QuintilesIMS, Frankfurt, Germany). People with epilepsy (PWE) with an initial cancer diagnosis and antiepileptic therapy prior to the index date were 1:1 matched with a control group of PWE without cancer according to age, gender, index year, Charlson Comorbidity Index, and treating physician. For both groups, the risk to develop cancer under treatment with different ASMs was analyzed using three different models (ever use vs. never use (I), effect per one (II) and per five therapy years (III). Results A total of 3152 PWE were included (each group, n = 1,576; age = 67.3 ± 14.0 years). The risk to develop cancer was not significantly elevated for any ASM. Carbamazepine was associated with a decreased cancer risk (OR Model I: 0.699, p < .0001, OR Model II: 0.952, p = .4878, OR Model III: 0.758, p < .0004). Significance Our findings suggest that ASM use does not increase the risk of cancer in epilepsy patients.

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CANCER OF THE ORGANS OF THE REPRODUCTIVE SYSTEM IN WOMEN WITH TYPE 2 DIABETES. EFFECTS OF ANTIDIABETIC THERAPY

Wiadomości Lekarskie ◽

10.36740/wlek202005124 ◽

2020 ◽

Vol 73 (5) ◽

pp. 967-971

Author(s):

Tamara S. Vatseba

Keyword(s):

Type 2 Diabetes ◽

Combination Therapy ◽

Postmenopausal Women ◽

Reproductive System ◽

Uterine Cancer ◽

Antidiabetic Therapy ◽

Increased Risk ◽

Risk Of Cancer ◽

The Impact

The aim: to investigate the prevalence of cancer of the reproductive system in women with type 2 diabetes, and to examine the impact of antidiabetic therapy on cancer risk of this localization. Materials and methods: The study included a retrospective analysis of medical records of women with T2D with first diagnosed cancer during 2012-2016. The bases for the study were specialized medical institutions in Ivano-Frankivsk region. The obtained results were processed using statistical programs “Microsoft Excel” and “Statistika-12”. Results: Breast, uterine, and ovarian cancer were detected in 202 postmenopausal women, 63.92% from the total number of cancer cases in women. An increased risk of breast [OR = 1.24; 95% CI (1.04 – 1.50) P = 0.019] and uterine cancer [OR = 1.32; 95% CI (1.02 – 1.69) P = 0.040] has been identified. Most often, before the detection of cancer, women received combination therapy with sulfonylurea and metformin (83 patients (57.64%)) with BMI 32.64 ± 3.69 kg/m2. The difference between risk of cancer on metformin monotherapy and on sulfonylurea monotherapy [OR = 2.17; 95% CI (0.88 – 5.36) P = 0.141] or on combination therapy [OR = 1.68; 95% CI (0.76 – 3.74) P = 0.276] was not found. Conclusions: Postmenopausal women have an increased risk of breast and uterine cancer and are recommended to be screened for these diseases

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Relationship between hypoglycaemia, cardiovascular outcomes, and empagliflozin treatment in the EMPA-REG OUTCOME® trial

European Heart Journal ◽

10.1093/eurheartj/ehz621 ◽

2019 ◽

Vol 41 (2) ◽

pp. 209-217 ◽

Cited By ~ 11

Author(s):

David Fitchett ◽

Silvio E Inzucchi ◽

Christoph Wanner ◽

Michaela Mattheus ◽

Jyothis T George ◽

...

Keyword(s):

Cox Regression ◽

Severe Hypoglycaemia ◽

Glycated Haemoglobin ◽

Protective Effects ◽

Increased Risk ◽

Symptomatic Hypoglycaemia ◽

Post Hoc ◽

The Impact ◽

Time Varying Covariates

Abstract Aims Hypoglycaemia, in patients with Type 2 diabetes (T2D) is associated with an increased risk for cardiovascular (CV) events. In EMPA-REG OUTCOME, the sodium-glucose co-transporter-2 inhibitor empagliflozin reduced the risk of CV death by 38% and heart failure hospitalization (HHF) by 35%, while decreasing glycated haemoglobin (HbA1c) without increasing hypoglycaemia. We investigated CV outcomes in patients with hypoglycaemia during the trial and the impact of hypoglycaemia on the treatment effect of empagliflozin. Methods and results About 7020 patients with T2D (HbA1c 7–10%) were treated with empagliflozin 10 or 25 mg, or placebo and followed for median 3.1 years. The relationship between on-trial hypoglycaemia and CV outcomes, and effects of empagliflozin on outcomes by incident hypoglycaemia [HYPO-broad: symptomatic hypoglycaemia with plasma glucose (PG) ≤70 mg/dL, any hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia, and HYPO-strict: hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia] was investigated using adjusted Cox regression models with time-varying covariates for hypoglycaemia and interaction with treatment. HYPO-broad occurred in 28% in each group and HYPO-strict in 19%. In the placebo group, hypoglycaemia was associated with an increased risk of HHF for both HYPO-broad [hazard ratio (HR, 95% confidence interval, CI) 1.91 (1.25–2.93)] and HYPO-strict [1.72 (1.06–2.78)]. HYPO-broad (but not HYPO-strict) was associated with an increased risk of myocardial infarction (MI) [HR 1.56 (1.06–2.29)]. Empagliflozin improved CV outcomes, regardless of occurrence of hypoglycaemia (P-for interactions >0.05). Conclusion In this post hoc exploratory analysis, hypoglycaemia was associated with an increased risk of HHF and MI. Hypoglycaemia risk was not increased with empagliflozin and incident hypoglycaemia did not attenuate its cardio-protective effects.

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Effect of anticoagulants and antiplatelet agents on the efficacy of intravesical BCG treatment of bladder cancer: A systematic review

Canadian Urological Association Journal ◽

10.5489/cuaj.1213 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 740 ◽

Cited By ~ 9

Author(s):

Nader Fahmy ◽

Alejandro Lazo-Langner ◽

Alla E. Iansavichene ◽

Stephen E. Pautler

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Bladder Tumour ◽

Antiplatelet Agents ◽

Protective Role ◽

Protective Effects ◽

Increased Risk ◽

Intravesical Bcg ◽

The Impact ◽

Group 1

We performed a systematic review of publications describing a correlation between oral anticoagulant medications and intravesical BCG outcome. We collected information on the impact of such medications on tumour recurrence and progression and we excluded papers not reporting outcome correlations. Patients were divided into group 1 and 2 based on whether they were taking or not taking any anticoagulant medications. A total of 7 manuscripts published between 1990 and 2009 were included in this study. Data heterogeneity precluded meta-analysis. In studies combining all anticoagulant medications, 3 out of 5 (60%) publications did not identify any difference in outcome, while 2 (40%) documented significantly more recurrences in group 1 patients. In studies performing multivariate analysis and only examining the intake of 1 medication, warfarin alone seemed to be associated with increased risk of bladder tumour recurrences and progression following intravesical BCG treatment, while ASA alone seemed to be associated with more protective effects. There is no strong evidence to support the allegations of a protective role of ASA and a deleterious role for warfarin. Further, well-designed experimental and clinical studies are needed to clarify the mechanism of action of intravesical BCG along with possible drug interactions.

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Cancer Risk in Children and Young Adults (Offspring) Born after Medically Assisted Reproduction: A Systematic Review and Meta-Analysis

J ◽

10.3390/j2040028 ◽

2019 ◽

Vol 2 (4) ◽

pp. 430-448

Author(s):

Manuela Chiavarini ◽

Andrea Ostorero ◽

Giulia Naldini ◽

Roberto Fabiani

Keyword(s):

Cancer Risk ◽

Health Outcomes ◽

Childhood Cancer ◽

Assisted Reproduction ◽

Meta Analysis ◽

Cancer Data ◽

Medically Assisted Reproduction ◽

Increased Risk ◽

Risk Of Cancer ◽

The Impact

Many studies have investigated the relationship between medically assisted reproduction (MAR) and health outcomes, particularly cancer, in the offspring. This meta-analysis investigated the association between MAR and childhood cancer. Data sources were PubMed, Scopus, and Web of Science up until June 2018. From the selected studies, we extracted the cancer risk estimates of the exposure of interest (MAR, assisted reproductive technology—ART, and in fitro fertilization—IVF). We conducted the meta-analysis using a random effects model. The outcomes of interest were childhood cancers, classified according to the international classification of childhood cancer (ICCC-3). In our meta-analysis (18 cohort and 15 case-control studies) the overall cancer risk was significantly increased in children conceived by MAR, ART, or IVF. MAR and ART significantly increased the risk for hematological tumors, hepatic tumors, and sarcomas (odds ratio (OR) 1.54; 95% CI 1.18–2.02 and OR 1.92; 95% CI 1.34–2.74, respectively). MAR increased acute myeloid leukemia risk (OR 1.41; 95% CI 1.02–1.95) and ART increased neural cancer risk (OR 1.21; 95% CI 1.01–1.46). Our results suggest an increased risk of cancer in children conceived by MAR. Further studies are needed to investigate the impact of fertility treatments, parental subfertility status, and their association on health outcomes in the offspring.

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Mortality and Risk of Cancer After Prophylactic Bilateral Oophorectomy in Women With a Family History of Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pky034 ◽

2018 ◽

Vol 2 (3) ◽

Cited By ~ 1

Author(s):

Julie Abildgaard ◽

Magnus Glindvad Ahlström ◽

Gedske Daugaard ◽

Dorte Lisbet Nielsen ◽

Anette Tønnes Pedersen ◽

...

Keyword(s):

Breast Cancer ◽

Family History ◽

Rate Ratio ◽

Bilateral Oophorectomy ◽

Family History Of Cancer ◽

Increased Risk ◽

History Of ◽

Risk Of Cancer ◽

The Impact ◽

History Of Cancer

Abstract Background Current international guidelines recommend systemic hormone therapy (HT) to oophorectomized women until the age of natural menopause. Despite an inherited predisposition to estrogen-dependent malignancies, the guidelines also apply to women oophorectomized because of a family history of cancer. The objective of this study was to investigate the impact of HT on mortality and risk of cancer in women oophorectomized because of a family history of cancer. Methods A nationwide, population-based cohort was used to study women oophorectomized because of a family history of cancer (n = 2002). Comparison cohorts included women from the background population individually matched on age (n = 18 018). Oophorectomized women were subdivided into three groups: oophorectomized at 1) age 45 years or younger not using HT, 2) age 45 years or younger using HT, 3) older than age 45 years, and their respective population comparison cohorts. Results Women oophorectomized at age 45 years or younger using HT had increased overall mortality (mortality rate ratio [MRR] = 3.45, 95% confidence interval [CI] = 1.53 to 7.79), mortality because of cancer (MRR = 5.67, 95% CI = 1.86 to 17.34), and risk of overall cancer (incidence rate ratio [IRR] = 3.68, 95% CI = 1.93 − 6.98), primarily reflected in an increased risk of breast cancer (IRR = 4.88, 95% CI = 2.19 − 10.68). Women oophorectomized at age 45 years or younger not using HT and women oophorectomized at older than age 45 years did not have increased mortality, mortality because of cancer, or risk of overall cancer, but they had increased risk of breast cancer (IRR = 2.64, 95% CI = 1.14 to 6.13, and IRR = 1.72, 95% CI = 1.14 to 2.59, respectively). Conclusions Use of HT in women oophorectomized at age 45 years or younger with a family history of cancer is associated with increased mortality and risk of overall cancer and breast cancer. Our study warrants further investigation to establish the impact of HT on mortality and cancer risk in oophorectomized women with a family history of cancer.

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PERILOUS HIV BRINGS OUT DEADLY CANCERS

International Journal of Indigenous Herbs and Drugs ◽

10.46956/ijihd.vi.104 ◽

2020 ◽

pp. 1-5

Author(s):

Camila A Carlman ◽

Bharat Mishra ◽

Anita Patel

Keyword(s):

Immune System ◽

Hodgkin Lymphoma ◽

Cancer Progression ◽

Kaposi's Sarcoma ◽

Cellular Proliferation ◽

Kaposi’S Sarcoma ◽

Hiv Patients ◽

Non Hodgkin Lymphoma ◽

Increased Risk ◽

Risk Of Cancer

Human Immunodeficiency Virus (HIV) infection is both infectious and contagious disease. The people infected with HIV have an increased risk of cancer while comparing with uninfected people. Kaposi’s sarcoma, aggressive B-cell Non-Hodgkin Lymphoma & cervical cancer are the three types of cancers which are termed as “HIV –associated cancers”. Apart from these cancers, HIV patients are prone to cancers of anus, liver, lung, pharynx which are termed as “non-AIDS defining cancers”. Viral oncogenesis and cytokine induced growth contribute to the development of Kaposi sarcoma. Several virally encoded genes such as bcl-2, IL-6, cyclin-D, GPCR & interferon regulatory factor, plays key role in cellular proliferation and survival. Infection with HIV weakens the immune system and reduces the body’s ability to fight against viral infections that may lead to cancer. Immunosuppression and inflammation in HIV patients also contribute to cancer progression. The complications of AIDS- related cancers include easy bleeding and bruising, tiredness, nausea, vomiting, poor appetite, mouth sores, hair loss etc. According to the data, HIV infected males are more susceptible to Kaposi’s sarcoma and Non- Hodgkin Lymphoma whereas females are more liable to cervical cancers. Early diagnosis and treatment options help to drop the risk of AIDS related cancers. The HAART therapy reduces the risk of cancer in HIV patients by lowering the amount of HIV circulating in blood, so that function of immune system to fight against the virus can be restored. Other treatment methods are chemotherapy, immunotherapy, radiation and surgery.

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Genetic risk for coronary heart disease alters the influence of Alzheimer’s genetic risk on mild cognitive impairment

10.1101/432443 ◽

2018 ◽

Author(s):

Jeremy A. Elman ◽

Matthew S. Panizzon ◽

Mark W. Logue ◽

Nathan A. Gillespie ◽

Michael C. Neale ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Genetic Risk ◽

Early Stage ◽

Case Fatality ◽

Polygenic Risk Score ◽

Protective Effects ◽

Increased Risk ◽

Incident Cases ◽

The Impact

ABSTRACTBACKGROUNDAlzheimer’s disease (AD) is under considerable genetic influence. However, known susceptibility loci only explain a modest proportion of variance in disease outcomes. This small proportion could occur if the etiology of AD is heterogeneous. We previously found that an AD polygenic risk score (PRS) was significantly associated with mild cognitive impairment (MCI), an early stage of AD. Poor cardiovascular health is also associated with increased risk for AD and has been found to interact with AD pathology. Conditions such as coronary artery disease (CAD) are also heritable, and may contribute to heterogeneity if there are interactions of genetic risk for these conditions as there is phenotypically. However, case-control designs based on prevalent cases of a disease with relatively high case-fatality rate such as CAD may be biased toward individuals who have long post-event survival times and may therefore also identify loci with protective effects.METHODSWe compared interactions between an AD-PRS and two CAD-PRSs, one based on a GWAS of incident cases and one on prevalent cases, on MCI status in 1,209 individuals.RESULTSAs expected, the incidence-based CAD-PRS interacts with the AD-PRS to further increase MCI risk. Conversely, higher prevalence-based CAD-PRSs reduced the effect of AD genetic risk on MCI status.CONCLUSIONSThese results demonstrate: i) the utility of including multiple PRSs and their interaction effects; ii) how genetic risk for one disease may modify the impact of genetic risk for another; and iii) the importance of considering ascertainment procedures of GWAS being used for genetic risk prediction.

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Cancer risk of aged people with HIV infection and of transplant people

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.20063 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 20063-20063

Author(s):

D. Serraino ◽

P. Piselli ◽

G. Busnach ◽

F. Citterio ◽

L. Fratino ◽

...

Keyword(s):

Cancer Risk ◽

Hiv Infection ◽

Older Individuals ◽

Aged People ◽

Highly Active ◽

Increased Risk ◽

The Difference ◽

Few Data ◽

Risk Of Cancer ◽

The Impact

20063 Background: Acquired immunesuppression due to HIV-infection or to anti-rejection therapies following organ transplantation is a well known risk factor for cancer. This increased risk has been well documented for young adults, whereas few data are available on older persons. In this study, we assessed the impact of cancer in HIV-positive persons (HIV+) and in transplant persons (TRP) who were 50 years of age or older. Methods: Data from a multi-cohort study conducted in Italy and France were analysed. Individuals ≥50 years of age were selected from the original study group constituted by 2002 HIV+ seroconverters from Italy, 6072 HIV+ from France and 2755 Italian TRP (1844 kidney, 702 heart, 159 liver and 50 lung TRP). Sex- and age-standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed to quantify the cancer risk as compared to the general population. Among HIV+, the risk of cancer was also assessed according to treatment with highly active antiretroviral therapies (HAART). Results: This analysis was based on 94 cancers diagnosed in 833 HIV+, and on 154 cancers diagnosed in 1558 TRP ≥50 years of age. The SIRs for all cancers decreased with ageing, ranging from 5.1 (95% CI: 4.0–6.5) in HIV+ aged 50–59 to 2.1 (95% CI: 1.4–3.1) in HIV+ aged 60 or older. In TRP, the SIRs for all cancer were 2.5 (95% CI:2.0–3.1) and 1.6 (95% CI: 1.2–2.0), respectively. In HIV+, the protective effect of HAART was more evident in those aged 50–59 (SIR = 6.8 in never treated and SIR = 2.4 in ever treated) than in HIV+ aged ≥60 (SIR = 2.8 and SIR = 1.6, respectively). This pattern of cancer occurrence was peculiar to virus-related cancers (e.g., Kaposi’s sarcoma, non-Hodgkin’s lymphoma, liver cancer). SIRs for lung cancer in both groups were significantly increased but did not significantly differ according to HAART and/or age. The survival of both HIV+ and TRP was significantly reduced by the diagnosis of cancer, but the difference in survival was not associated with ageing (p = 0.20). Conclusions: Aged individuals with acquired immunesuppression have a cancer pattern similar to younger persons with immunosuppression, but the burden of cancer will increase in absolute terms because of the increasing proportion of older individuals among both HIV+ and TRP. No significant financial relationships to disclose.

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Self-reported health and survival in older patients diagnosed with multiple myeloma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6582 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6582-6582

Author(s):

Nadia Azmi Nabulsi ◽

Ali Alobaidi ◽

Brian Talon ◽

Alemseged Ayele Asfaw ◽

Jifang Zhou ◽

...

Keyword(s):

Multiple Myeloma ◽

Medical Condition ◽

Self Report ◽

Increased Risk ◽

All Cause Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Reported Health ◽

Risk Of Cancer ◽

The Impact

6582 Background: The strength of associations between pre-diagnosis self-reported health (SRH) and mortality differ by medical condition, with a moderately strong association reported among cancer patients. Less is known about the impact of SRH on survival among patients diagnosed with multiple myeloma (MM). We aimed to evaluate pre-diagnosis SRH in relation to survival in a cohort of older MM patients. Methods: We analyzed a prospective cohort from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database of patients 65 years and older diagnosed with first primary MM. Survey responses to a single general health question (asking patients to self-report their health as excellent, very good, good, fair, or poor) were used to determine pre-diagnosis SRH, grouped as high (excellent/very good/good) or low (fair/poor). We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between SRH and risks of all-cause and cancer-specific mortality. Results: Of 521 MM patients with pre-diagnosis SRH data, the mean (SD) age at diagnosis was 76.8 (6.1) years with 60% of patients identifying as white, 18% as black, and 32% reporting low SRH. Compared to patients reporting high SRH, patients reporting low SRH were older, had lower education levels, more comorbidities, and lower Veterans-RAND 12 physical health and mental health component summary scores. In multivariable analyses, MM patients with low SRH had a 28% increased risk of all-cause mortality (HR = 1.28, 95% CI = 1.00, 1.64) and a non-statistically significant 19% increased risk of cancer-specific mortality (HR = 1.19, 95% CI = 0.87, 1.61) compared to MM patients reporting high SRH. Conclusions: Our findings suggest that lower SRH is highly prevalent among MM patients prior to diagnosis and is associated with modestly increased all-cause mortality. At a minimum, low SRH deserves clinical attention to determine how older MM patients’ quality of life may be compromised. The mechanism by which SRH affects mortality in MM should be further assessed and efforts should be made to identify whether any of the underlying mechanisms linking SRH and mortality in MM are mutable.

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