Although a large percentage of women undergoing curative-intent treatment for breast cancer were prescribed opioids, only a small number developed new persistent opioid use, according to data from a retrospective study reported in the Journal of the National Comprehensive Cancer Network.1 However, among the smaller number of patients prescribed benzodiazepines, new persistent use after treatment completion was not only found to be more likely, but also to correlate with concurrent treatment with tamoxifen.
The investigators identified 33,288 opioid-naïve women who were undergoing curative-intent treatment for breast cancer between 2008 and 2013 in the Surveillance, Epidemiology, and End Results-Medicare linked database. The mean patient age was 75.8 years. Primary outcomes included new persistent opioid use and new persistent benzodiazepine use.
A total of 22,418 (67.4%) women were found to be new opioid users. However, only 2.7% developed persistent opioid use at 3 months. This number decreased to 0.7% at 6 months after treatment.
The most commonly prescribed opioids included hydrocodone (60.5%), oxycodone (17.8%), and tramadol (12.2%). Results indicated that 10.3% of patients filled a new benzodiazepine prescription during the treatment period. Of them, 11.6% developed persistent use at 3 months after treatment. Use of tamoxifen was significantly associated with new persistent benzodiazepine use at 3 months (odds ratio [OR], 1.93; 95% CI, 1.12-3.33), as was depression/anxiety (OR, 1.74; 95% CI, 1.01-3.01).
Notably, patients with higher stages of disease had a higher propensity of receiving a new opioid prescription, but only women with stage III disease were more likely to have continued opioid use at 3 months (OR, 2.16; 95% CI, 1.49-3.12) and 6 months (OR, 3.48; 95% CI, 1.58-7.67). The data also showed that patients who underwent surgery plus either chemotherapy (OR, 1.94; 95% CI, 1.75-2.14) or chemoradiation (OR, 1.79; 95% CI, 1.61-1.99) were more likely to fill a new opioid prescription vs those who only underwent surgery.
“These findings demonstrate the importance of identifying high-risk patients, educating providers on non-opioid and non-benzodiazepine approaches, and counseling patients throughout all phases of care,” the researchers concluded.
Sakamoto MR, Eguchi M, Azelby CM, et al. New persistent opioid and benzodiazepine use after curative-intent treatment in patients with breast cancer. J Natl Compr Canc Netw. 2021;19(1):29-38. doi:10.6004/jnccn.2020.7612