Quality-of-Life Outcomes for Patients Taking Opioids and Psychotropic Medications Before Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

• Published in: Annals of surgical oncology Vol. 31; no. 1; pp. 577 - 593
• Main Authors: Solsky, Ian, Patel, Ana, Valenzuela, Cristian D., Russell, Gregory, Perry, Kathleen, Duckworth, Katie, Votanopoulos, Konstantinos I., Shen, Perry, Levine, Edward A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2024; Springer Nature B.V
• Subjects: Analgesics, Opioid - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer therapies; Chemotherapy; Combined Modality Therapy; Cytoreduction Surgical Procedures - adverse effects; Emotions; Epidemiology; Humans; Hyperthermia, Induced - adverse effects; Hyperthermic Intraperitoneal Chemotherapy; Medicine; Medicine & Public Health; Narcotics; Oncology; Opioid receptors (type delta); Patients; Peritoneal Neoplasms - therapy; Peritoneal Surface Malignancy; Quality of Life; Retrospective Studies; Statistical analysis; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-14215-7

Background
The impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) on quality of life (QoL) for patients taking opioids and psychotropic medications preoperatively is unclear.
Methods
This study retrospectively reviewed a CRS-HIPEC single-center prospectively maintained database for 2012–2016. Demographics and clinical data on opioids/psychotropic medication use were collected via chart review. The study collected QoL outcomes at baseline, then 3, 6, and 12 months postoperatively via the Center for Epidemiologic Studies Depression Scale (CES-D), Brief Pain Inventory, Functional Assessment of Cancer Therapy, and 36-Item Short-Form Health Survey. Differences in QoL between the groups were calculated using repeated measures analysis of variance regression. Descriptive statistics and Kaplan-Meier analyses were performed.
Results
Of 388 patients, 44.8% were taking opioids/psychotropic medications preoperatively. At baseline, those taking opioids/psychotropic medications preoperatively versus those not taking these medications had significantly worse QoL. By 1 year postoperatively, the QoL measures did not differ significantly except for emotional functioning (e.g., no medications vs. opioids/psychotropic medications: CES-D, 5.6 vs. 10.1). Median survival did not differ significantly (opioids/psychotropic medications vs. no medications: 52.3 vs. 60.6 months;
p
= 0.66). At 1 year after surgery, a greater percentage of patients were taking opioids, psychotropic medications, or both than at baseline (63.2% vs. 44.8%;
p
< 0.001).
Conclusion
Despite worse baseline QoL, patients who took opioids/psychotropic medications had QoL scores 1 year postoperatively similar to the scores of those who did not except in the emotional domains. These data point to the potential utility of a timed psychosocial intervention to enhance emotional adaptation and further support the role of CRS-HIPEC in improving QoL.