Mental Health Affects Opioid Use, Survival in Breast Cancer Patients

A retrospective study found that breast cancer patients with anxiety, depression, or other mental illnesses are more likely to be opioid users and have higher mortality rates.

“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,” the study authors wrote. Their findings were published in the Journal of Oncology Practice.

The study included SEER-Medicare data sets from 2006 to 2012. Eligible patients were women aged 65 years or older who were diagnosed with stage I, II, or III breast cancer and were fee-for-service Medicare enrollees in Medicare Parts A, B, and D. All patients were followed for a minimum of two years from the first day they filled an AET prescription.

Final analysis included 10,452 breast cancer patients who initiated AET treatments. The most prevalent mental health diagnoses 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 study authors observed.

The findings suggest that certain patients may require different treatment plans, according to Rajesh Balkrishnan, PhD, the study’s lead researcher.

“The complex relationship among breast cancer, mental health problems, and the use of opioids is not well understood and the results of this study provide clinicians the evidence they need to make optimal patient treatment related decisions,” Dr. Balkrishnan, of the Department of Public Health Sciences and the UVA Cancer Center, said in a press release. “Our findings suggest that patients with breast cancer with mental health conditions have higher opioid use and reduced survival. These results highlight the need for health care providers to evaluate treatment goals and assess whether better concurrent management of breast cancer and mental health conditions is required.”

According to the American Psychological Association (APA), women diagnosed with breast cancer may turn to substances including alcohol, cigarettes, caffeine, or other drugs to cope with the stress of their diagnosis. Depression is also a possibility, the APA notes, which could create a challenge for women to seek support or follow through with treatment. Even after becoming cancer-free, emotional recovery could also be very taxing, possibly even outliving physical recovery.