Mental Health Comorbidity Tied to Opioid Use, Lower Survival in Breast Cancer

Older women with breast cancer who have a concurrent mental health condition are more likely to use opioids and have worse survival outcomes.

Opioid use and mortality are higher among older women with breast cancer who also have mental health conditions, according to a new study published in the Journal of Oncology Practice.

Although prolonged opioid use is known to be linked to lower survival rates in those with a history of breast cancer, the relationship between breast cancer, mental health, and opioids is not well understood, the study noted.

Mental health conditions are prevalent among patients with breast cancer, with approximately 40% of those diagnosed with the disease who have some type of concurrent mental health comorbidity, according to the researchers.

For the study, the authors aimed to determine whether opioid use was affected by the prevalence of mental health comorbidity in individuals with a history of breast cancer administered adjuvant endocrine therapy (AET) regimens.

Using more than 10,000 breast cancer cases recorded in the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program database, the researchers reviewed data on 10,452 women with incident, primary, hormone receptor breast cancer. The women were also first-time AET users and fee-for-service Medicare enrollees. Among these women, the most commonly diagnosed mental health comorbidities were depression and anxiety.

Overall, the researchers determined that opioid use was significantly higher in women with a mental health comorbidity (odds ratio, 1.33; 95% CI, 1.06 to 1.68). Mental health comorbidity was also associated with a significantly increased hazard of mortality in this population (hazard ratio, 1.49; 95% CI, 1.02 to 2.18), according to the study.

“Opioid use is higher in the women with breast cancer who suffer from mental health conditions and remains a significant problem,” the researchers wrote in a paper outlining the findings. “In addition, mental health comorbidities also contribute to reduced survival in these women. A need exists for collaborative care in the management of mental health comorbidities in women with breast cancer, which could improve symptoms.”

They added that the findings suggest better concurrent management of mental health conditions and breast cancer, as well as complementary pain management options such as physical therapy, massage, and acupuncture are needed.

References

Desai R, Camacho F, Tan X, et al. Mental health comorbidities and elevated risk of opioid use in elderly breast cancer survivors using adjuvant endocrine treatments. Journal of Oncology Practice. 2019. https://doi.org/10.1200/JOP.18.00781

Depression, Anxiety Linked to Opioid Use in Women With Breast Cancer [news release]. University of Virginia Health System. https://newsroom.uvahealth.com/2019/08/22/depression-anxiety-linked-to-opioid-use-in-women-with-breast-cancer/. Accessed August 27, 2019.