If an MD gave you a prescription and told you it would make your tumor grow or worse would create metastases or stimulate progression of the cancer, would you take the drug? Most tell me: absolutely not – are you crazy? Yet, when I tell them their doctors are doing this routinely they draw back from me for daring to suggest their doctors are prescribing drugs that are increasing the cancer they are trusting the doctors to treat and shrink.
Cancer and pain in many cases go hand in hand. Bone pain is extremely painful, those with bone metastases as well as those with bone cancer find pain an unwelcome companion or more so an intruder. Pain after cancer surgery is always followed by the administration of opiates. Since this is the norm for cancer patients why should we worry or question what doctors are prescribing?
Morphine is the most common of all opiates prescribed. Cancer thrives on being exposed to opiods, particularly morphine. It is used for common cancer pain and used for post surgical pain in cancer surgeries. When tumors are exposed to the opiods the tumors grow faster and develop more extensive networks of blood supply that the tumors use to feed their progression. This process is called angiogenesis.
Dr Patrick Singleton told the American Association for Cancer Research summit that morphine also appeared to make it easier for cancers to invade other tissues.
Not only does the Morphine contribute to further growth and metastases especially after surgery but another concern is researchers have discovered is the general anesthesia used may contribute to the spreading of the cancer after surgery. After surgery patients’ immune system is weakened by the anesthesia and the administration of the morphine presented against the receptors in the cancer cells allows them to grow faster. Dr Jonathan Moss MD, PhD, professor of anesthesiology and critical care at the University of Chicago Medicine stated: “Epidemiologic findings suggest that the type of anesthesia we do for cancer surgery influences recurrence rate, and laboratory studies demonstrate that opioids influence tumor progression and metastasis. These studies have caused anesthesiologists to re-evaluate how best to do anesthesia and pain control for cancer patients.”
Researchers have found cells from a variety of human lung cancers had 5 to 10 times as many opioid receptors as non- cancerous lung cells. They discover after mapping out the biochemical pathways Akt and mTOR, targets for chemotherapies and are triggered when the receptors are contacted by the endogenous opioids. This interaction can increase proliferation, migration and invasion of tumor cells. In this same study they found human lung cells with these additional opioid receptors grew more than twice as fast as tumor cells that lacked the additional receptors. They also found the cancer was 20 times more likely to spread and cause metastases in distant areas of the body. If the receptors are blocked using such medications as naloxone or methylnatrexone reduced the spread. The findings concluded if you can block the receptors it may help stop the progression.
In 2002 in Cancer Research it was reported: “These results indicate that clinical use of morphine could potentially be harmful.”
Researchers at the University of Minnesota published a study showing doses of morphine similar to those that are used to ease pain will stimulate the growth of human breast cancer cells. How could this be? Morphine is often the most common pain easer for cancer patients and often used in hospice. In Ireland in 2006 patients that underwent surgery to remove breast or prostate cancer were less prone to metastases if local or regional anesthesia was used rather than general anesthesia; they are usually not given morphine as the pain level is usually not as severe. This gives cause for us to consider the immune system is not compromised allowing them to find stray cells easier without the interference of the anesthesia and the morphine is not stimulating the growth by way of the opioid receptors.
Still after near a decade cancer specialists are highly skeptical and look for trials to determine if there is a true correlation between the use of morphine and cancer progression. Do we continue based research done a decade ago and present research, to administer morphine to cancer patients or do we decide to err on the side of caution therefore discover other drugs that can relieve the pain? How can one try to treat the cancer and feed it at the same time?
Many cancer patients after extensive surgery are in a hospice situation or are put into hospice when treatments are found not beneficial. For many they could live and thrive for some time in hospice but there is usually a sudden decline in patients put into hospice. Could the morphine usually administered to hospice patients have a direct link to sudden worsening of the patients? Many nurses or doctors have an attitude about late stage cancer patients. They find it acceptable to use morphine regularly.
Patients and family members need to know the dangerous effects of morphine, both in the progression of the cancer you are trying to fight and overcome to the ability to live as long as possible. When a doctor prescribes morphine you need to question why. If you want to live and beat your cancer you need to protect yourself by demanding a pain relief that is not an opioid that will further your cancer’s progression. No one should prescribe morphine with an attitude that you need to die with dignity – it is not their choice – it is always your choice and right to live and fight the cancer.
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