title: Chronic opioid therapy in long-term cancer survivors.
abstract: OBJECTIVE
  Long-term cancer survivors develop special health issues and specific needs. Chronic pain, whether the consequence of their cancer or as a side effect of treatment, is one of their most prevalent concerns.
  
  
  METHODS
  We conducted a review of the English-language literature on long-term cancer survivorship and chronic opioid therapy, with the objective of determining the efficacy, safety and tolerability in this group of patients. Practical management recommendations are made on the basis of this review.
  
  
  RESULTS
  Pain syndromes encountered in the long-term cancer survivors are diverse. Opioid receptor pathways possess complex and pleiotropic functions and continuous over-activation may lead to de novo endocrinopathies, immunosuppression, neurocognitive impairment, or cell cycle disturbances with potential clinical connotations. However, there are insufficient data to support evidence-based decision making with respect to patient selection, doses, administration, monitoring and follow-up. Data about long-term treatment effectiveness and safety are limited and often aggravated by the overlapping of several diseases prevalent among long-term cancer survivors, as well as chronic opiate-induced toxicity.
  
  
  CONCLUSIONS
  Chronic opioid therapy is frequent in long-term cancer survivors, and may negatively affect the immune system, and produce health problems such as endocrinopathies, osteoporosis, neurological or cardiopulmonary effects, alterations of cell cycle kinetics, abuse and addiction. This review highlights the need for specialized teams to treat chronic pain in long-term cancer survivors from an integrative perspective.
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Avenue Marqués de los Vélez, s/n, 30008, Murcia, Spain. alberto.carmonabayonas@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Castañón
authors.affiliation: Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ramchandani-Vaswani
authors.affiliation: Medical Oncology Department, Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Avenida Pío XII, 36, Pamplona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Sánchez-Bayona
authors.affiliation: Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Custodio
authors.affiliation: Radiology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Principado de Asturias, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Calvo-Temprano
authors.affiliation: Medical Oncology Department, Hospital Virgen de la Macarena, Avd. Doctor Fedriani, 3, 41071, Seville, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Virizuela
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D017741:Survivors
chemical_list: D000701:Analgesics, Opioid
keywords: Cancer; Chronic opioid therapy; Chronic pain; Opioids; Survivors