Mental Health Comorbidities and Elevated Risk of Opioid Use in Elderly Breast Cancer Survivors Using Adjuvant Endocrine Treatments

Abstract

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.