Tan Xi, Camacho Tareq Fabian, LeBaron Virginia T, Blackhall Leslie J, Balkrishnan Rajesh
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Department of Public Health Sciences, School of Medicine, University of Virginia, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA.
Breast Cancer Res Treat. 2017 Sep;165(2):455-465. doi: 10.1007/s10549-017-4348-8. Epub 2017 Jun 21.
To explore differences in opioid use across different adjuvant endocrine therapy (AET) regimens, factors associated with opioid use, and the impact of opioid use on overall survival in female breast cancer patients treated with AET.
This retrospective study analyzed 2006-2012 SEER-Medicare datasets, following patients for at least two years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone-receptor-positive, stage I-III breast cancer. They were also first-time AET users, and fee-for-service Medicare enrollees continuously enrolled in Medicare Parts A, B, and D. The main independent variable was the AET regimen. We measured whether patients used opioids after the initiation of AET.
After the adjustment of inverse probability treatment weights and unbalanced covariates, the average treatment effect probabilities of opioid use were similar between those who used aromatase inhibitors (AI) only and those used tamoxifen (TAM) only (56.2 vs. 55.3%, respectively). Opioid use probabilities for those who switched from AI to TAM were higher than those for the TAM-only and AI-only groups. Opioid use was also significantly associated with AET non-adherence. Opioid users had a significantly higher risk of death (adjusted hazard ratio [HR] = 1.59, p < 0.001).
Switching from AI to TAM was associated with a high likelihood of opioid use. Opioid use was significantly associated with AET non-adherence and higher risk of mortality in female Medicare beneficiaries with breast cancer even after adjusting for adherence.
探讨不同辅助内分泌治疗（AET）方案中阿片类药物使用情况的差异、与阿片类药物使用相关的因素，以及阿片类药物使用对接受AET治疗的女性乳腺癌患者总生存期的影响。
这项回顾性研究分析了2006 - 2012年的监测、流行病学和最终结果（SEER）-医疗保险数据集，从索引日期开始对患者进行至少两年的随访，索引日期定义为他们首次开具AET处方的日期。该研究纳入了患有新发、原发性、激素受体阳性、I - III期乳腺癌的成年女性。她们也是首次使用AET的患者，并且是按服务收费的医疗保险参保者，持续参保医疗保险A、B和D部分。主要自变量是AET方案。我们测量了患者在开始AET治疗后是否使用阿片类药物。
在调整逆概率治疗权重和不平衡协变量后，仅使用芳香化酶抑制剂（AI）的患者和仅使用他莫昔芬（TAM）的患者中阿片类药物使用的平均治疗效果概率相似（分别为56.2%和55.3%）。从AI转换为TAM的患者的阿片类药物使用概率高于仅使用TAM和仅使用AI的组。阿片类药物使用也与AET治疗不依从显著相关。阿片类药物使用者的死亡风险显著更高（调整后的风险比[HR]=1.59，p<0.001）。
从AI转换为TAM与阿片类药物使用的高可能性相关。即使在调整依从性后，阿片类药物使用在患有乳腺癌的女性医疗保险受益人中也与AET治疗不依从和更高的死亡风险显著相关。
