Mesothelioma Surgery and the Threat of Opioid Addiction

A new study of opioid addiction among lung cancer patients may have implications for pleural mesothelioma patients who are considering surgery.

The study, published this month in JAMA Oncology, finds that patients treated with more invasive surgical techniques are more likely to become chronic opioid users than those who have less invasive surgery.

Opioids Are ‘Standard of Care’ for Lung Surgery Patients

Researchers at Mount Sinai Medical Center in New York studied the cases of nearly 4,000  people from the SEER Medicare database who had some type of surgery for non-small cell lung cancer, a type of cancer that shares many commonalities with the lung-related asbestos cancer, pleural mesothelioma.

Some of the lung cancer patients studied underwent open thoracic surgery while others underwent video-assisted thoracoscopic surgery (VATS), a less invasive option that involves an internal camera and a few small incisions. About 71 percent of patients were given prescriptions for opioid medications to deal with post-surgical pain.

“While the current standard of care is to prescribe opioids at discharge, this treatment is intended as short-term pain control, not to exceed a few weeks after surgery,” notes lead author Stephanie Tuminello, MPH.

Opioid Use after Lung Cancer Surgery

In spite of the intention for opioids to be only a short-term fix, three to six months later, more than 15 percent of the lung cancer patients were still taking those opioid medications. Notably, those who underwent the more invasive type of surgery were much more likely to have become long-term opioid users.

“Our study suggests that surgical invasiveness might play a role in the odds of becoming a long-term opioid user after surgery,” writes Tuminello. “Patients undergoing VATS were less likely to use opioids both in the immediate postoperative period and long-term, even after adjusting for relevant covariates.”

Given the growing issue of opioid addiction in the US, the authors say more research is needed into how pain management after surgery could be contributing to the problem.

Minimally Invasive Mesothelioma Surgery

Although the current study does not directly address the issue of opioid use among mesothelioma patients, treatment similarities between lung cancer and pleural mesothelioma suggest the results are relevant.

Fortunately, minimally invasive options for mesothelioma treatment are in development.

Earlier this month, Japanese doctors reported their success treating recurrent pleural mesothelioma with a minimally invasive radiofrequency ablation technique normally used to alleviate pain.

Last year, a team of Chinese researchers declared VATS surgery (also called thoracoscopy) “valuable and safe” for mesothelioma diagnosis and symptom management after evaluating more than 800 patients with pleural cancers.

Two additional studies in 2018 led by Spanish researchers confirm the feasibility and safety of a minimally invasive CRS/HIPEC technique for the treatment of small peritoneal mesothelioma tumors.

Source:

Tuminello, S, et al, “Video-Assisted Thoracoscopic Surgery for early-Stage Lung Cancer”, September 24, 2018, JAMA Oncology, Epub ahead of print