Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

References:

• K. Luk, S. Boatman, and K. N. Johnson, “Influence of morphine on pericyte-endothelial interaction:implications for antiangiogenic therapy,” Journal of Oncology, vol. 2012, Article ID 458385, 10 pages, 2012. 

• K. Gupta, S. Kshirsagar, L. Chang et al., “Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth,” Cancer Research, vol. 62, no. 15, pp. 4491–4498, 2002. View at Scopus
• M. Farooqui, Y. Li, T. Rogers et al., “COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia,” British Journal of Cancer, vol. 97, no. 11, pp. 1523–1531, 2007. View at Publisher · View at Google Scholar · View at Scopus
• B. Biki, E. Mascha, D. C. Moriarty, J. M. Fitzpatrick, D. I. Sessler, and D. J. Buggy, “Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis,” Anesthesiology, vol. 109, no. 2, pp. 180–187, 2008. View at Publisher · View at Google Scholar · View at Scopus
• B. Mathew, F. E. Lennon, J. Siegler et al., “The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation,” Anesthesia and Analgesia, vol. 112, no. 3, pp. 558–567, 2011. View at Publisher · View at Google Scholar · View at Scopus
• P. A. Singleton, M. W. Lingen, M. J. Fekete, J. G. N. Garcia, and J. Moss, “Methylnaltrexone inhibits opiate and VEGF-induced angiogenesis: role of receptor transactivation,” Microvascular Research, vol. 72, no. 1-2, pp. 3–11, 2006. View at Publisher · View at Google Scholar · View at Scopus
• S. Leo, R. Nuydens, and T. F. Meert, “Opioid-induced proliferation of vascular endothelial cells,” Journal of Pain Research, vol. 2, pp. 59–66, 2009. View at Scopus

FDA (U.S.) Safety Alert > Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume

Safety Alerts for Human Medical Products > Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume


[Posted 04/18/2012]
AUDIENCE: Risk Manager, Pain Management
ISSUE: Customer report of two Carpujects syringes containing more than the 1 mL labeled fill volume. Opioid pain medications such as morphine have life-threatening consequences if overdosed. Those consequences can include respiratory depression (slowed breathing or suspension of breathing), and low blood pressure.
BACKGROUND: The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 10830LL, with an expiration date of April 1, 2013. Morphine Sulfate Carpujects 4 mg/mL are packaged in Slim-Pak tamper detection packages with each box containing 10 Carpujects (NDC 0409-1258-30).
The affected lot was distributed in January 2012. It was initially distributed to wholesalers and a limited number of hospitals in Arizona, Colorado, Hawaii, Illinois, Indiana, Michigan, Minnesota, Ohio, Texas and Virginia.
RECOMMENDATION: Anyone with an existing inventory of affected product should stop use and distribution and quarantine the product immediately and call Stericycle at 1-888-912-7088 to arrange for the return of the product.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

• Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

abstract: [Assessment of health-related quality of life in cancer outpatients treated with chemotherapy] Japanese study

[Assessment of health-related quality of life in cancer outpatients treated with chemotherapy].


Abstract
Purpose: 
Few studies have been conducted to elucidate the health-related quality of life(HR-QOL) of cancer outpatients treated with chemotherapy. In this study, we attempted to determine the physical and psychological distress of cancer outpatients treated with chemotherapy.

Methods:
Two-hundred and ninety-six outpatients with various malignancies, including malignant lymphoma, and esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, were investigated using the Japanese version of the M. D. Anderson symptom inventory from March through June 2010 in Tokyo Medical University Hospital.

Results:
The results of the survey questionnaire indicated that 59 patients suffered from fatigue, 56 experienced numbness or tingling, 48 felt drowsy, 39 had low moods, 40 felt distressed, 38 had no appetite, 38 had dry mouth, 37 were in pain, 37 had disturbed sleep, 31 had shortness of breath, 24 had nausea, 17 suffered from vomiting, and 13 patients had memory problems. Furthermore, these symptoms interfered with work(65 patients), walking(56 patients), mood(52 patients), life enjoyment(49 patients), general activity(49 patients), and relationships with other people(42 patients). Medications prescribed for HR-QOL control were non-steroidal anti-inflammatory drugs (93 patients), morphine(32 patients), and adjuvant analgesics(47 patients).

Conclusion:
The present findings may help in the development of management strategies for physical and psychological distress, and improve HR-QOL of cancer outpatients treated with chemotherapy.

open access: As-Needed Morphine: Yes, but at What Dose and at What Interval?

..........Given the above-illustrated opinion conflicts, with a 10-fold variation in dose and a six-fold variation in timing interval, a search through published sources was conducted, mirroring a wide range of combinations regarding recommendations for both the PRN narcotic doses and the appropriate intervals at which they should be repeated in the event of continued pain. Data from 22 review articles and texts that review guidelines for the treatment of cancer pain, presented in Table 3, ^1-22 provided a 20-fold variation in recommended narcotic doses (1% to 20% of daily doses) along with scattered opinions, or no direction, regarding appropriate dose intervals for potential repeat doses...............

.............Specific guidelines for prescribing opioids are needed to allow practitioners to feel comfortable in administering these medications. These guidelines must include how to determine the appropriate dose for breakthrough pain, and the appropriate and safe interval that will allow for rapid pain relief, but maintain patient safety. On completion of this project, the 2004 National Comprehensive Cancer Network guidelines for cancer pain were found.²⁷ These guidelines come to similar conclusions that recommend the use of intravenous narcotic doses of 10% to 20% of the daily intravenous morphine equivalent and the use of repeat doses at 15-minute intervals, if pain is still present. The information from this project might be used to facilitate continuous-improvement projects at individual institutions. Such a project is in process locally. The incorporation of this new information regarding PRN narcotic use should better serve the needs of patients.

Informa Healthcare: Can morphine still be considered to be the standard for treating chronic pain? A systematic review

"Based on these results, a justification for the placement of morphine as the reference standard for the treatment of severe chronic pain cannot be supported."

In response to recent media: Does Morphine Stimulate Cancer Growth? | GeriPal - A Geriatrics and Palliative Care Blog

Please read the full article/discussion. Many questions were asked and responses given which may be helpful for many.

Over the last week Reuters, ABC news, MSNBC, BBC News, and more than 75 other outlets reported on how two "two new studies add to growing evidence that morphine and other opiate-based painkillers may promote the growth and spread of cancer cells." What was most shocking were the headlines used to promote the stories:

* Morphine 'might spread cancer' (BBC News)
* Morphine May Help Tumors Spread in Cancer Patients (US News and World Reports)
* Pain drug morphine may accelerate cancer growth (Reuters, ABC News)
* Common Pain Relief Medication May Encourage Cancer Growth (Science Daily)