Patients with early-stage breast cancer who underwent mastectomy or mastectomy with reconstruction were at increased risk of prolonged and extra-prolonged opioid use, according to an observational study published in The Oncologist.
Opioids are commonly prescribed after surgery, and many patients have unused opioids once their need for analgesia has ended. Most studies of opioid use and abuse have focused on patients without cancer, but patients with early-stage breast cancer typically undergo mastectomy or lumpectomy and may be prescribed opioids for postsurgical analgesia. The purpose of this study was to evaluate prolonged use of opioids after curative surgery for early-stage breast cancer.
This observational study included 23,440 women from the IBM Truven Health MarketScan database diagnosed with early-stage breast cancer between January 2000 to December 2014. All women were opioid-naive prior to their curative surgery and underwent either mastectomy with or without reconstruction or lumpectomy with or without radiation (whole-breast irradiation [WBI] or brachytherapy). Patients filled at least 1 opioid prescription associated with their surgery.
The primary endpoint was prolonged opioid use, which was defined as use 90 to 180 days after surgery. Extra-prolonged opioid use was defined as 1 opioid prescription filled between 181 and 365 days after surgery. Risk factors for prolonged or extra-prolonged opioid use were assessed by multivariable logistic regression.
Prolonged opioid use occurred among 18% of patients and 9% of patients engaged in extra-prolonged opioid use. Patients who underwent mastectomy most commonly demonstrated prolonged opioid use (15%), particularly if they also underwent reconstruction (38%).
“Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering,” the authors wrote.
In the multivariate analysis, women who underwent mastectomy with reconstruction (odds ratio [OR], 5.56; 95% CI, 5.06-6.10) or without reconstruction (OR, 1.66; 95% CI, 1.47-1.88) had the greatest odds of prolonged opioid use compared with women who underwent lumpectomy and WBI. Increased odds of extra-prolonged opioid use was also associated with mastectomy with reconstruction (OR, 4.51; 95% CI, 3.97-5.13; P <.0001) or without reconstruction (OR, 1.35; 95% CI, 1.13-1.61; P =.001) compared with lumpectomy with WBI.
Later timeframe of diagnosis, presence of comorbidities, depression, anxiety, substance use disorder, chemotherapy, and positive node were also associated with greater odds of prolonged and extra-prolonged opioid use.
The authors concluded that the study “highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.”
Shen C, Thornton JD, Gu D, et al. Prolonged opioid use after surgery for early-stage breast cancer. Oncologist. 2020;25:1-9.