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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.

Boland, Jason W; Allgar, Victoria; Boland, Elaine G; Bennett, Mike I; Kaasa, Stein; Hjermstad, Marianne Jensen; Johnson, Miriam

Authors

Jason W Boland

Victoria Allgar

Elaine G Boland

Mike I Bennett

Stein Kaasa

Marianne Jensen Hjermstad



Abstract

Purpose
Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making.

Methods
Secondary 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.

Results
Date 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

Journal Article Type Article
Journal European Journal of Clinical Pharmacology
Print ISSN 0031-6970
Electronic ISSN 1432-1041
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
APA6 Citation Boland, J. W., Allgar, V., Boland, E. G., Bennett, M. I., Kaasa, S., Hjermstad, M. J., & Johnson, M. (in press). 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. European Journal of Clinical Pharmacology, https://doi.org/10.1007/s00228-019-02801-2
DOI https://doi.org/10.1007/s00228-019-02801-2
Keywords Pharmacology (medical); Pharmacology; General Medicine; Neoplasms; Pain; Analgesics; Opioids; Survival
Additional Information Received: 13 August 2019; Accepted: 18 November 2019; First Online: 21 December 2019; : ; : None of the authors declare any conflicts of interest.; : Central Norway Regional Health Authority (grant no. 46055100), The Cancer Foundation St Olavs Hospital, Norway, Trondheim University Hospital (grant no. 6070) and an unrestricted grant from the Helsinn group, Switzerland.

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