By Kate O’Rourke
Women who undergo mastectomy and reconstruction surgery may face the risk of long-term dependence on opioids and sedative-hypnotic drugs, according to research presented at the 2020 San Antonio Breast Cancer Symposium.
Around the time of breast cancer surgery, opioids are frequently prescribed for pain, and sedative-hypnotics may be prescribed for anxiety or insomnia. In the new study, researchers used the MarketScan health care claims database to evaluate prescriptions for opioids and sedative-hypnotics among women who underwent mastectomy and reconstruction between 2008 and 2017 (Abstract GS3-08).
The researchers identified prescriptions during three time periods: the pre-operative period (365 days to 31 days prior to surgery), the perioperative period (31 days prior to 90 days after surgery), and the post-operative period (90 days to 365 days after surgery). New chronic users were defined as patients who had no use in the pre-operative period, but at least one prescription in the perioperative period and at least two prescriptions in the post-operative period. Patients filling multiple prescriptions for controlled substances in the year prior to surgery were categorized as prior persistent users and were not included in the analysis.
Among 25,270 women who were not prior users of opioids and 27,651 who were not prior users of sedative-hypnotics, the researchers found that 13.1% became new persistent opioid users after mastectomy and reconstruction and 6.6% became new persistent sedative-hypnotic users.
After removing patients who did not receive or fill a perioperative controlled substance prescription, the rates of persistent opioid use rose to 17.5% and the rate of persistent sedative-hypnotic use rose to 17%. Women who were younger than 65 years of age, women with Medicaid insurance, women with a breast cancer diagnosis versus those who had prophylactic surgery, and women treated with chemotherapy were at a higher risk of becoming a persistent user for both types of controlled substances.
“As the number of risk factors [for substance use] increases, the rates of controlled substances increases,” said Jacob Cogan, MD, the study’s lead author and a fellow in hematology/oncology at New York-Presbyterian/Columbia University Irving Medical Center in New York City.
Two risk factors were associated with an odds ratio of 2.27 of becoming a new persistent user of opioid use and with five risk factors, the odds increased to 6.34. In terms of developing persistent use of sedative hypnotics, three risk factors were associated with an odds ratio of 4.56, while four risk factors jumped to an odds ratio of 7.23.
Patients should be vigilant about taking these medications only when necessary and work closely with their physician to attempt to minimize the risk of dependence, Dr. Cogan said.
“[This study] suggests that there is high risk of new chronic controlled substance abuse among women who underwent mastectomy and reconstruction,” said Carlos Arteaga, MD, Director of the Simmons Comprehensive Cancer Center and Lisa K. Simmons Distinguished Chair in Comprehensive Oncology at UT Southwestern Medical Center in Dallas, Texas, who was not involved with the study.