TY - JOUR
T1 - Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer
AU - Shen, Chan
AU - Thornton, J. Douglas
AU - Gu, Dian
AU - Dodge, Daleela
AU - Zhou, Shouhao
AU - He, Weiguo
AU - Zhao, Hui
AU - Giordano, Sharon H.
N1 - Funding Information:
This study is funded in part by National Institute on Drug Abuse grant 1R03DA047597, National Cancer Institute grant P30 CA016672, Cancer Prevention and Research Institute of Texas grant RP160674, and Komen grant SAC150061.
Funding Information:
This study is funded in part by National Institute on Drug Abuse grant 1R03DA047597, National Cancer Institute grant P30 CA016672, Cancer Prevention and Research Institute of Texas grant RP160674, and Komen grant SAC150061.
Publisher Copyright:
© AlphaMed Press 2020
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Introduction: This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve working-age patients with early-stage breast cancer. Methods: Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extra-prolonged use of opioids. Findings: Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1–6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use. Interpretation: This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type. Implications for Practice: This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.
AB - Introduction: This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve working-age patients with early-stage breast cancer. Methods: Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extra-prolonged use of opioids. Findings: Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1–6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use. Interpretation: This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type. Implications for Practice: This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.
KW - Early-stage breast cancer
KW - Health services research
KW - Lumpectomy
KW - Mastectomy
KW - Prolonged opioid use
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U2 - 10.1634/theoncologist.2019-0868
DO - 10.1634/theoncologist.2019-0868
M3 - Article
C2 - 32390251
AN - SCOPUS:85085752519
SN - 1083-7159
VL - 25
SP - e1574-e1582
JO - Oncologist
JF - Oncologist
IS - 10
ER -