|The following article features coverage from the 2020 San Antonio Breast Cancer Symposium. Click here to read more of Cancer Therapy Advisor‘s conference coverage.|
Women who had a mastectomy with breast reconstruction for breast cancer treatment may be at risk for becoming dependent on opioids and sedative-hypnotic drugs, showed a study presented at the 2020 Virtual San Antonio Breast Cancer Symposium (SABCS).
“Prior studies have shown that 10% of patients undergoing cancer-related surgery become new persistent users of opioids post operatively,” said study presenter Jacob Cogan, MD, a fellow in hematology/oncology at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City. “This is higher than the 7% rate observed in patients undergoing noncancer surgery.”
Using the IBM Truven MarketScan health care claims database, study researchers identified women who had a mastectomy with breast reconstruction between 2008 and 2017. Data on when women filled a prescription for opioids of sedative-hypnotics were gathered and grouped into 3 time periods: the preoperative, perioperative, and postoperative time periods.
The preoperative period was the time between 365 days and 31 days before surgery. The perioperative period was the time between 31 days before surgery and 90 days after surgery. The postoperative period was the time between 90 days and 365 days after surgery.
Patients were excluded if they filled multiple prescriptions for controlled substances in the year prior to surgery. A total of 25,270 patients who had not filled a prescription for opioids and 27,651 who had not filled a prescription for sedative hypnotics were included in the cohort.
Among patients who were opioid-naive, 13.1% became new persistent users of opioids, meaning they filled a prescription in the perioperative period and at least 2 prescriptions in the postoperative period. Among patients who were sedative-hypnotic–naive, 6.6% became new persistent users of sedative hypnotics.
When patients who never filled a prescription were excluded, the rates of new persistent users rose to approximately 17% for each drug class.
Predictors of new persistent use of opioids or sedative hypnotics were having Medicaid insurance, being diagnosed with breast cancer, receiving chemotherapy treatment, or being aged younger than 65 years. As the number of risk factors increased for patients, so did the odds of becoming a new persistent user for either drug class.
When asked how to incorporate these findings into clinical practice, Dr Cogan encouraged physicians to ask patients if they are still taking opioids or sedative-hypnotics. If patients are no longer taking that medication, physicians can encourage them to dispose of it.
“That’s something that maybe we don’t think of doing,” he said. “But that in itself could help get these medications out of the house and prevent patients from using them in other situations.”
Read more of Cancer Therapy Advisor‘s coverage of the 2020 SABCS meeting by visiting the conference page.
Cogan JC, Raghunathan RR, Beauchemin MP, et al. Persistent controlled substance use following mastectomy with reconstruction surgery. Presented at: 2020 Virtual San Antonio Breast Cancer Symposium; December 8-11, 2020. Abstract GS3-08.