Encouraging Findings Regarding Persistent Opioid Use in Older Women with Breast Cancer

Persistent opioid use was an infrequent occurrence among older adult patients with breast cancer completing cancer treatment between 2008 and 2013, according to a study published in Cancer.

Due to the concerning trends in opioid use seen in noncancer populations, researchers noted that this finding was encouraging; however, opportunities to further mitigate unsafe opioid use as a complication of cancer care should be explored.

“Although persistent opioid use was an infrequent consequence of breast cancer diagnosis and treatment, the high rates of breast cancer diagnosis and long-term survival as well as current uncertainty about what constitutes problematic long-term opioid use patterns may necessitate increased scrutiny of the appropriate role of prescription opioids in managing acute and chronic cancer-related pain,” the authors wrote. 

This study used Surveillance, Epidemiology, and End Results-Medicare data from opioid-naïve women diagnosed with stage 0 to III breast cancer at the age of 66 to 90 years between 2008 and 2003 to estimate overall and quarterly adjusted probabilities of new-onset opioid use.

Data indicated that nearly half of the subjects received at least 1 opioid prescription during cancer treatment, and only 2.8% developed new-onset persistent opioid use. Persistent opioid use was more common among patients who received chemotherapy compared to those who did not (4.9% vs 2.4%; P < .01), though there were fewer chemotherapy patients filling any opioid prescription after active treatment (41% of the chemotherapy group vs 49% of the nonchemotherapy group; P < .01). Additionally, a larger proportion of the subjects who received chemotherapy filled an opioid prescription during their active cancer treatment than those in the larger nonchemotherapy subset (82% vs 55%; P < .01).

In sensitivity analyses, the alternative outcome definition resulted in predicted probabilities ranging from 11.4% to 14.7%. The authors indicated that this data identifies a larger subset of the population that initiates opioid therapy as persistent opioid users and might inflate the perceived severity of the issue at a population level, dissuading providers from prescribing opioid therapy when it could be clinically appropriate. However, the primary definition of persistent opioid use utilized in this study may risk understating the problem, causing some high-risk patients to be overlooked.

“We recommend more detailed analyses in the future of the intensity and temporality of opioid use during active cancer treatment and its association with long-term opioid use in survivorship to assess the robustness of our measure of opioid exposure during active cancer treatment,” the authors wrote.

Period, age, chemotherapy status, type of surgical intervention, radiation, hormone therapy, and tumor size were not significantly associated with the risk of new-onset persistent opioid use. However, the risk of new-onset persistent opioid use significantly increased as the breast cancer stage, baseline comorbidity burden, and length of active cancer treatment increased. 

Moreover, black women were less likely to develop new-onset persistent opioid use compared to white women (RR, 0.62; 95% CI, 0.46-0.84; P < .01). Subjects with more advanced disease, a higher comorbidity burden, a low-income status, and greater opioid exposure during active cancer treatment were more likely to form persistent opioid use.

Researchers indicated that further work is necessary to determine optimal strategies for identifying problematic persistent opioid use and how these measures should be tailored on the basis of pain medications and population characteristics. 

Reference:

Roberts AW, Fergestrom N, Neuner JM, Winn AN. New-Onset Persistent Opioid Use Following Breast Cancer Treatment in Older Adult Women. Cancer. doi:10.1002/cncr.32593.