Opioid and Benzodiazepine Relative Use in Breast Cancer Patients Before, During, and After Curative Chemotherapy

Yau, Warren; Roeland, Eric; Revta, Carolyn; Ale-Ali, Amine; Joseph, Deepa

doi:10.1080/15360288.2018.1479328

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…57,58 Among breast cancer survivors at an academic cancer center who had completed chemotherapy 3 months earlier, 16% had overlapping prescriptions for opioids and benzodiazepines. 59 Our larger, nationally representative sample found a higher rate (25%) of benzodiazepine coprescribing during LTOT among breast cancer survivors, and this elevates concern for this population. A study by Haider et al 60 found that 31% of patients with cancer receiving opioids in a palliative care clinic also received benzodiazepines.…”

Section: Discussionmentioning

confidence: 76%

Safety of opioid prescribing among older cancer survivors

Salz

Mishra

Gennarelli

et al. 2021

Cancer

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BACKGROUND:Cancer survivors receive more long-term opioid therapy (LTOT) than people without cancer, but the safety of LTOT prescribing is unknown. METHODS: Opioid-naive adults aged ≥66 years who had been diagnosed in 2008-2015 with breast, lung, head and neck, or colorectal cancer were identified with data from Surveillance, Epidemiology, and End Results cancer registries linked with Medicare claims. Survivors with 1 or more LTOT episodes (≥90 consecutive days) occurring ≥1 year after their cancer diagnosis and before censoring at hospice entry, another cancer diagnosis, 6 months before death, or December 2016 were included. The safety of prescribing during the first 90 days of the first LTOT episode was measured during follow-up. As a positive safety indicator, the proportion of survivors with concurrent nonopioid pain management was measured. Indicators of less safe prescribing were the proportion of survivors with a high average daily opioid dose (≥90 morphine milligram equivalents) and the proportion of survivors with concurrent benzodiazepine dispensing. Multivariable logistic regression analyses were conducted to identify clinical predictors of each safety outcome. RESULTS: In all, 3628 cancer survivors received LTOT during follow-up (median duration, 4.9 months; interquartile range, 3.5-8.0 months). Seventy-two percent of the survivors received multimodal pain management concurrently with LTOT. Eight percent of the survivors had high-dose opioid prescriptions; 25% of the survivors received benzodiazepines during LTOT. Multivariable analyses identified variations in safety measures by multiple clinical factors, although none were consistently significant across outcomes. CONCLUSIONS: To improve safe LTOT prescribing for survivors, efforts should focus on increasing multimodal pain management and reducing inappropriate benzodiazepine prescribing. Different clinical predictors of each outcome suggest different drivers of safe prescribing.

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Section: Discussionmentioning

confidence: 76%

Safety of opioid prescribing among older cancer survivors

Salz

Mishra

Gennarelli

et al. 2021

Cancer

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“…37 In contrast, a single-center study showed 33% of patients with breast cancer remained on benzodiazepines 90 days after curative chemotherapy; however, sample size was small, patients were younger, and those with prior benzodiazepine use were not excluded. 30 Risk factors for benzodiazepine use during and after breast cancer treatment have not been previously reported. Multimodality treatment that includes surgery combined with chemotherapy with or without RT was associated with a 4-fold increased risk of benzodiazepine use during the treatment period.…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28] Our results are more comparable to the 57% of patients with breast cancer who received opioids during adjuvant endocrine therapy 29 and the 31% to 45% during curativeintent chemotherapy. 30 We also identified several treatment-and patient-related factors that were predictive of new opioid use. Aromatase inhibitors were associated with short-term opioid use, whereas tamoxifen was not.…”

Section: Discussionmentioning

confidence: 99%

New Persistent Opioid and Benzodiazepine Use After Curative-Intent Treatment in Patients With Breast Cancer

Sakamoto¹,

Eguchi²,

Azelby³

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Opioid and benzodiazepine use and abuse is a national healthcare crisis to which patients with cancer are particularly vulnerable. Long-term use and risk factors for opioid and benzodiazepine use in patients with breast cancer is poorly characterized. Methods: We conducted a retrospective population-based study of patients with breast cancer diagnosed between 2008 and 2015 undergoing curative-intent treatment identified through the SEER-Medicare linked database. Primary outcomes were new persistent opioid use and new persistent benzodiazepine use. Factors associated with new opioid and benzodiazepine use were investigated by univariate and multivariable logistic regression. Results: Among opioid-naïve patients, new opioid use was observed in 22,418 (67.4%). Of this group, 611 (2.7%) developed persistent opioid use at 3 months and 157 (0.7%) at 6 months after treatment. Risk factors for persistent use at 3 and 6 months included stage III disease (odds ratio [OR], 2.16; 95% CI, 1.49–3.12, and OR, 3.48; 95% CI, 1.58–7.67), surgery plus chemotherapy (OR, 1.44; 95% CI, 1.10–1.88, and OR, 2.28; 95% CI, 1.40–3.71), surgery plus chemoradiation therapy (OR, 1.47; 95% CI, 1.10–1.96, and OR, 2.34; 95% CI, 1.38–3.96), and initial tramadol use (OR, 2.66; 95% CI, 2.05–3.46, and OR, 3.12; 95% CI, 1.93–5.04). Among benzodiazepine-naïve patients, new benzodiazepine use was observed in 955 (10.3%), and 111 (11.6%) developed new persistent use at 3 months. Tamoxifen use was statistically significantly associated with new persistent benzodiazepine use at 3 months. Conclusions: A large percentage of patients receiving curative-intent treatment of breast cancer were prescribed new opioids; however, only a small number developed new persistent opioid use. In contrast, a smaller proportion of patients received a new benzodiazepine prescription; however, new persistent use after completion of treatment was more likely and particularly related to concurrent treatment with tamoxifen.

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“…Rates of sedative-hypnotic use and misuse in women with breast cancer have only been previously studied to a limited degree [7,32]. One recent study assessed benzodiazepine use in elderly patients with breast cancer undergoing curative intent treatment using SEER-Medicare data [29].…”

Section: Discussionmentioning

confidence: 99%

New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

Cogan

Raghunathan

Beauchemin

et al. 2021

Breast Cancer Res Treat

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Prolonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M+R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications. MethodsUsing the MarketScan health care claims database, we identi ed opioid-and sedative-hypnotic-naïve women who had M+R from 2008-2017. Women who lled ≥1 peri-operative prescription and ≥2 post-operative prescriptions within one year after surgery were classi ed as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors. ResultsWe evaluated 25,270 opioid-naïve women and 27,651 sedative-hypnotic-naïve women.We found that 18,931 opioid-naïve women lled a peri-operative opioid prescription, and of those, 3,315 (17.5%) became opioid NPUs postoperatively. Additionally, 10,781 sedative-hypnotic-naïve women lled a peri-operative sedative-hypnotic prescription, and of those, 1,837 (17.0%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤49 (OR 1.79 [95% CI 1.43-2.25]) and age 50-64 (1.65 [1.31-2.07]) compared to age ≥65; Medicaid insurance (1.92 [1.23-2.98]); southern residence (1.38 [1.20-1.59]); breast cancer diagnosis (1.78 [1.09-2.91]); and chemotherapy (2.24 [2.02-2.49]). Risk of NPU increased with higher risk score. Women with ≥3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors (3.03 [2.60-3.53]). Comparable ndings were seen regarding new persistent opioid use. ConclusionWomen who have M+R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient's risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.

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Opioid and Benzodiazepine Relative Use in Breast Cancer Patients Before, During, and After Curative Chemotherapy

Cited by 6 publications

References 6 publications

Safety of opioid prescribing among older cancer survivors

Safety of opioid prescribing among older cancer survivors

New Persistent Opioid and Benzodiazepine Use After Curative-Intent Treatment in Patients With Breast Cancer

New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

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