Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer

The oncologist

article

Chan Shen¹  J. Douglas Thornton³  Dian Gu⁴  Daleela Dodge¹  Shouhao Zhou²  Weiguo He⁴  Hui Zhao⁴  Sharon H. Giordano⁴ 

[1] Department of Surgery, College of Medicine, The Pennsylvania State University;Department of Public Health Sciences, College of Medicine, The Pennsylvania State University;Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston;Department of Health Services Research, University of Texas MD Anderson Cancer Center;Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center

关键词: Prolonged opioid use;    Early-stage breast cancer;    Mastectomy;    Lumpectomy;    Health services research;   

DOI  :  10.1634/theoncologist.2019-0868

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Introduction This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve working-age patients with early-stage breast cancer. Methods Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extra-prolonged use of opioids. Findings Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1–6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use. Interpretation This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type. Implications for Practice This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.

【 授权许可】

CC BY|CC BY-NC