Patrice Forget, MD, anesthesiologist, department of anesthesiology, St-Luc Hospital, Brussels, Belgium.
You certainly don’t have to be a middle-aged woman to yearn for good news in the war against breast cancer, but the issue does have a special poignancy for me and other women in my life and perhaps in yours, too. It’s heartening to hear of a study showing that a pain drug commonly used during mastectomy actually can lower the risk of the cancer’s recurrence.
Belgian researchers who studied 327 women undergoing mastectomy found that presurgical administration of ketorolac (Toradol), a powerful nonsteroidal anti-inflammatory drug (NSAID), was associated with a significantly reduced rate of recurrence. Women given ketorolac had a recurrence rate of 6% compared with 17% for women who had the same surgery but were given other analgesics. The study, which followed the women for up to four years, appeared in the June 2010 issue of the journal of the International Anesthesia Research Society, Anesthesia & Analgesia.
Ketorolac is used during many surgical procedures, usually for short-term pain relief after surgery. To learn more about this, I contacted the study’s lead author, Patrice Forget, MD, an anesthesiologist at St-Luc Hospital in Brussels. Just how does ketorolac prevent cancer relapse? Do other NSAIDs work as well? What about other analgesics? Dr. Forget provided answers to these questions and others.
First we need to understand what happens inside the body during cancer surgery. Dr. Forget explained that handling and cutting cancerous tissue (as is done during surgery) has the potential to release cancer cells into the bloodstream and lymphatic system. Making matters worse, the trauma of surgery also suppresses the immune system, impairing white blood cells known as natural killer (NK) cells, which protect and defend against tumors, and also boosting production of prostaglandins, molecules that play a key role in the development of tumors.
According to Dr. Forget, ketorolac likely works to reduce recurrence by inhibiting the production of prostaglandins during surgery. He noted that this is especially the case when the drug is administered just before surgery so that it can provide immunosuppression that lasts from the first postoperative hours all the way through a few days later.
When I asked Dr. Forget whether women having mastectomy should ask their doctors to use ketorolac, he said that it might make sense to do so. (Note: The drug is contraindicated for those with kidney disease, a bleeding or clotting disorder, ulcer or asthma and it also interacts with certain drugs.) He said that it is possible that other NSAIDs may also inhibit tumor growth, adding that more study is needed to explore the differences among NSAIDs and between NSAIDs and other pain relievers (since pain is the result of beefed up prostaglandin production).
In fact, said Dr. Forget, patients should be aware that pain management in general is a highly important part of cancer treatment that is too often underestimated. Pain-relief drugs not only help you feel better, it seems, but may in fact help cancer patients stay healthy.