Women who undergo mastectomy with reconstructive surgery as part of breast cancer treatment may face the risk of persistent use of opioids and sedative-hypnotic drugs, according to data presented by Jacob Cogan, MD, and colleagues at the 2020 San Antonio Breast Cancer Symposium (Abstract GS3-08).

“It has become clear that short-term exposure to opioids for any reason can lead to long-term dependence, given the highly addictive potential of these agents,” explained Dr. Cogan, the study’s lead author and a fellow in Hematology/Oncology at NewYork-Presbyterian/Columbia University Irving Medical Center. “Many patients receive this initial exposure around the time of surgery, and patients with cancer are at particularly high risk of becoming dependent on opioids postoperatively.”

Jacob Cogan, MD

Dr. Cogan added that another class of addictive medications—sedative-hypnotics—are frequently prescribed to patients with cancer, but have received less attention than opioids. Patients with cancer may receive sedative-hypnotic prescriptions around the time of surgery to combat anxiety or insomnia. In this study, Dr. Cogan and colleagues aimed to assess the risk of patients with breast cancer becoming dependent on opioids and/or sedative-hypnotic drugs after mastectomy with reconstruction surgery.

Study Methods

Researchers used the MarketScan health-care claims database to evaluate women who underwent mastectomy and breast reconstruction between 2008 and 2017. They identified prescriptions for opioids and sedative-hypnotics during three time periods: the preoperative period (365 days to 31 days prior to surgery); the perioperative period (31 days prior to 90 days after their surgery); and the postoperative period (90 days to 365 days after surgery).

The researchers identified 25,270 women who were not prior users of opioids and 27,651 who were not prior users of sedative-hypnotics. Patients who had no use in the first time period—but filled at least one prescription in the perioperative period and at least two prescriptions in the postoperative period—were considered new chronic users.

Results

Results showed that 13.1% of opioid-naive patients become new persistent opioid users after mastectomy and reconstruction. Meanwhile, 6.6% of sedative-hypnotic–naive patients become new persistent sedative-hypnotic users. When removing “nonuser” patients from these groups (ie, those who did not receive or fill a perioperative controlled substance prescription), the rates rose to 17.5% and 17%, respectively.

The study also found that the chance of becoming a persistent user of both types of controlled substances was significantly increased among women younger than age 60, those with a breast cancer diagnosis (vs those who had prophylactic surgery), and those treated with chemotherapy. As the number of risk factors increased, the risk of becoming a persistent user also increased.

“I hope that our study can increase awareness that these are addictive medications, and a brief exposure for surgery-related pain or anxiety can lead to long-term use,” said Dr. Cogan. “Both patients and providers should be aware of this issue and of the risk factors that elevate an individual patient’s risk.”

Dr. Cogan clarified that the study results do not suggest that opioids and sedative-hypnotic drugs should be avoided. “Rather, patients should be vigilant about taking these medications only when necessary, and they should work closely with the prescribing provider to attempt to minimize risk of dependence,” he said.

Dr. Cogan noted that a limitation of the study is that it is based on claims that providers submitted to insurance companies—these may not be fully accurate and are not submitted in a uniform fashion from provider to provider.

Disclosure: This study was funded by the Breast Cancer Research Foundation and the National Institutes of Health. Dr. Cogan reported no conflicts of interest.