Risk of second breast cancer events with chronic opioid use in breast cancer survivors

Abstract

Purpose Opioids may increase cancer risk and progression through multiple pathways. Our objective was to estimate the association between chronic opioid use and risk of second breast cancer events (SBCEs). Methods Cohort study of women greater than or equal to 18 years, diagnosed with early stage breast cancer between January 1, 1990, and December 31, 2008, and enrolled in a large health plan for 1+ years before and after (unless died) diagnosis. SBCEs were defined as evidence of recurrence or second primary breast cancer in the medical chart. Chronic opioid use was defined as 75+ days of use in any moving 90‐day window after breast cancer diagnosis and varied to 150+ days in a 180‐day window in a sensitivity analysis. Using Cox proportional hazards models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for SBCE and components of SBCE by chronic opioid use. Results Almost 10% met the criteria for chronic use and almost a third of users were taking opioids for greater than 3 years. Risk of SBCEs (HR = 1.20; 95% CI, 0.85‐1.70), including second primary breast cancer (HR = 1.38; 95% CI, 0.71‐2.70), was nonsignificantly higher among chronic users vs nonchronic/nonusers. The HR for recurrence was 1.14 (95% CI, 0.76‐2.70). Results of the sensitivity analyses on longer opioid use does support an association with SBCE or recurrence. Conclusion This first US‐based study on chronic opioid use and cancer outcomes provides some reassurance on safety. However, the question warrants further exploration in other populations and settings.

Anaesthesia as an influence in tumour progression

“…A retrospective analysis found no correlation between the total amount of consumed opioids after curative lung cancer resection and long-term survival or recurrence rates [ 40 ]. Similar results were found in two large cohort studies on postoperative chronic opiate use after breast cancer surgery [ 41 , 42 ]. However, a further retrospective study of a single centre showed a significant reduction in overall survival.…”

Oral Analgesic Use in Postmenopausal Women After Curative Breast Cancer Treatment: Post Hoc Analysis of the ATAC Trial

“…The proportion of patients using opioids in the current study was higher than that reported in other studies in breast cancer survivors, which reported chronic opioid use ranging from 2% to 10%. These differences may have been, in part, related to the definitions of chronic opioid use used in those studies (continuous use for ≥75 to ≥90 days) relative to the definition in the current study (analgesic use ≥30 days) [27][28][29]. Among patients using opioid-containing oral analgesics in the current study, nearly three-quarters reported no laxative use despite treatment guidelines for both cancer and noncancer patients that recommend utilization of laxatives for the treatment and prevention of opioid-induced constipation (Pappagallo [20] and NCCN guidelines [21]), which would have been available at the time of ATAC.…”

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

“…Some studies investigated opioid use among patients with various specific health conditions: 43 studies 24,26–28,31,37,43,48,49,51,52,59,62,65,70,74,77–80,82–104 focused on noncancer pain, 14 studies 55,56,64,69,105–114 on musculoskeletal conditions, 13 studies 38–40,57,81,115–122 on injuries or trauma and eight studies 23,32,53,67,75,123–125 on infectious diseases. Seven studies 41,44,45,71,126–128 included patients with both cancer and noncancer pain, and six studies evaluated patients with cancer 60,129,130 or cancer survivors 61,131,132 . (Table 1)…”

“…LTOT definitions were based on previous publications (81 studies, 63%), clinical judgment (21 studies, 16%) or empirical data (four studies, 3%) (see Table 2), and only 13 studies 34,51,58,60,63,66,79,80,92,97,132,138,139 tested more than one definition (10%).…”