University of Florida, Gainesville, FL.
University of Virginia, Charlottesville, VA.
J Oncol Pract. 2019 Sep;15(9):e777-e786. doi: 10.1200/JOP.18.00781. Epub 2019 Jul 19.
Prolonged opioid use is common and associated with lower survival rates in breast cancer survivors. We explored whether opioid use in elderly breast cancer survivors using adjuvant endocrine therapy (AET) regimens was affected by the prevalence of mental health comorbidity and, in turn, how this affected survival in this population.
This retrospective study analyzed 2006 to 2012 SEER-Medicare data sets and followed patients for at least 2 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 to 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. We measured whether patients with a clinical diagnosis of a mental health comorbid condition used opioids after the initiation of AET and their survival at the end of the study period.
A total of 10,452 breast cancer survivors who began AET treatments were identified, among whom the most commonly diagnosed mental health comorbidities were depression (n = 554) and anxiety (n = 246). Using a propensity score risk adjustment model, we found that opioid use was significantly higher in women with a mental health comorbidity (odds ratio,1.33; 95% CI, 1.06 to 1.68). In addition, mental health comorbidity was associated with a significantly increased hazard of mortality in this population (hazard ratio, 1.49; 95% CI, 1.02 to 2.18).
The presence of mental health comorbidity in breast cancer survivors significantly increases the risk of opioid use and mortality, which highlights the need for better management of comorbid mental health conditions.
延长阿片类药物的使用在乳腺癌幸存者中很常见，与较低的生存率相关。我们探讨了接受辅助内分泌治疗（AET）方案的老年乳腺癌幸存者中阿片类药物的使用是否受到心理健康合并症的流行率的影响，以及这反过来如何影响该人群的生存。
这项回顾性研究分析了 2006 年至 2012 年 SEER-医疗保险数据集，并从索引日期（定义为首次开处 AET 处方的日期）开始至少随访患者 2 年。该研究纳入了患有初发性、原发性、激素受体阳性、I 期至 III 期乳腺癌的成年女性。她们也是首次接受 AET 治疗且是医疗保险 A、B 和 D 部分连续参保的按服务收费的 Medicare 参保人。我们衡量了患有心理健康合并症临床诊断的患者在开始 AET 后是否使用阿片类药物，以及他们在研究期末的生存情况。
确定了 10452 名开始 AET 治疗的乳腺癌幸存者，其中最常见的诊断为心理健康合并症为抑郁症（n = 554）和焦虑症（n = 246）。使用倾向评分风险调整模型，我们发现患有心理健康合并症的女性使用阿片类药物的比例明显更高（比值比，1.33；95%置信区间，1.06 至 1.68）。此外，在该人群中，心理健康合并症与死亡率显著增加的风险相关（风险比，1.49；95%置信区间，1.02 至 2.18）。
乳腺癌幸存者存在心理健康合并症会显著增加使用阿片类药物和死亡的风险，这突出表明需要更好地管理合并的心理健康状况。
