Mental Health Comorbidities Among Elderly Breast Cancer Survivors Linked With Opioid Use

Previous research has indicated that approximately 40% of patients with breast cancer experience some type of mental health condition, and now new findings suggest that elderly women who survive the disease and experience a mental health condition are more likely to use opioids.

Among more than 10,000 women breast cancer survivors aged 65 years or older who started adjuvant endocrine therapy, those who had a mental health comorbidity were 33% more likely to use opioids than those without a mental health condition.

“The complex relationship among breast cancer, mental health problems and the use of opioids is not well understood, and the results of this study provide the evidence they need to make optimal patient treatment-related decisions,” Rajesh Balkrishan, PhD, professor of public health sciences at the University of Virginia (UVA) School of Medicine and co-program director of Cancer Control Core at the UVA Cancer Center, said in a statement.

Morbidity also impacted mortality risk, with these women having a nearly 50% (49%) increased risk of mortality.

The women, identified through the Surveillance, Epidemiology, and End Results database, were diagnosed with stage I, II, or III breast cancer between 2006 and 2012. Each woman was followed for 2 years following initiation of adjuvant endocrine therapy.

The findings highlight the need for better management of comorbid conditions in both encouraging alternative pain management—such as physical therapy, cognitive behavioral therapy, and acupuncture—and practicing more comprehensive, collaborative care.

“A need exists for collaborative care in the management of mental health comorbidities in women with breast cancer, which could improve symptoms, adherence to treatment, and recovery from these mental health conditions,” wrote the researchers.

They also highlighted the importance of leveraging primary care to address the management of mental health conditions, writing: “Mental health treatments also are recommended to be offered in primary care, which would be convenient for patients, but also would reduce the stigma associated with treatments for mental health comorbidities and improve the patient—provider relationship.”

The researchers did note several limitations of the study, including a lack of information on the opioids used by patients, as well as a lack of data on details on patients’ pain assessments. With mental health conditions potentially going underdiagnosed, the researchers also noted that their research may have underestimated the amount of patients with mental health conditions.

Reference

Desai R, Camacho F, Tan X, LeBaron V, Blackhall L, Balkrishan R. Mental health comorbidities and elevated risk of opioid use in elderly breast cancer survivors using adjuvant endocrine treatments [published online July 19, 2019]. J Oncol Pract. doi: 10.1200/JOP.18.00781.