Haque Reina, Chen Lie Hong, Shi Jiaxiao, Gu Zheng, Brady-Rogers Moira, Chlebowski Rowan T, Hechter Rulin C
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, United States.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, United States.
Oncologist. 2025 Mar 10;30(3). doi: 10.1093/oncolo/oyae270.
Little information exists on adverse effects related to opioid use in breast cancer survivors following active cancer treatment, and no studies included an age-matched comparison group. Thus, we examined opioid use and risk of falls, fractures, lung problems, and cardiovascular events in breast cancer survivors in the years following active cancer treatment along with a comparison group.
We conducted a longitudinal cohort study 33 989 breast cancer survivors and 157 609 age-matched women without cancer. Rates of adverse events, and multivariable hazards ratios for association between opioid use and the adverse health effects were calculated.
Women with breast cancer had greater opioid use (60% vs 48%); longer median opioid duration (18 vs 16 days); and were prescribed stronger opioids than the matched cohort over 5.6 median years of follow-up. In multivariable models, the risk of falls was 12% higher (HR, 95% CI, 1.12 [1.07-1.17]), and fracture risk was 56% (HR = 1.56 [1.48-1.65]) greater in women with breast cancer who used opioids vs the matched cohort unexposed to opioids. In an analysis restricted to women with breast cancer, opioid use was strongly associated with the risk of falls (HR = 1.74 [1.63-1.85]); fractures (HR = 2.10 [1.95-2.27]); lung problems (HR = 1.53 [1.43-1.64]); and cardiovascular events (HR = 1.70 [1.39-2.08]) than opioid non-use.
After active cancer treatment, opioid use and high dosage use were common in breast cancer survivors, and were associated with increased risk for falls, lung problems, fractures, and cardiovascular events. Findings underscore the need for careful monitoring of opioid use in these survivors and the exploration of alternative pain management strategies.
关于癌症积极治疗后乳腺癌幸存者使用阿片类药物的不良反应信息较少，且没有研究纳入年龄匹配的对照组。因此，我们研究了乳腺癌幸存者在癌症积极治疗后的几年中使用阿片类药物的情况以及跌倒、骨折、肺部问题和心血管事件的风险，并与一个对照组进行了比较。
我们对33989名乳腺癌幸存者和157609名年龄匹配的无癌女性进行了一项纵向队列研究。计算了不良事件发生率以及阿片类药物使用与不良健康影响之间关联的多变量风险比。
在中位随访5.6年期间，乳腺癌女性使用阿片类药物的比例更高（60%对48%）；阿片类药物使用的中位持续时间更长（18天对16天）；并且与匹配队列相比，她们被开具了更强效的阿片类药物。在多变量模型中，使用阿片类药物的乳腺癌女性跌倒风险高出12%（风险比，95%置信区间，1.12[1.07 - 1.17]），骨折风险高出56%（风险比 = 1.56[1.48 - 1.65]），而匹配队列中未使用阿片类药物。在仅针对乳腺癌女性的分析中，与未使用阿片类药物相比，使用阿片类药物与跌倒风险（风险比 = 1.74[1.63 - 1.85]）、骨折风险（风险比 = 2.10[1.95 - 2.27]）、肺部问题（风险比 = 1.53[1.43 - 1.64]）和心血管事件（风险比 = 1.70[1.39 - 2.08]）密切相关。
在癌症积极治疗后，阿片类药物的使用和高剂量使用在乳腺癌幸存者中很常见，并且与跌倒、肺部问题、骨折和心血管事件的风险增加相关。研究结果强调了对这些幸存者使用阿片类药物进行仔细监测以及探索替代疼痛管理策略的必要性。
