Elderly breast cancer patients with anxiety, depression or other mental health conditions are more likely to use opioids. They are also more likely to die from opioid use.
This is the conclusion from a new study led by Rajesh Balkrishnan, Ph.D, at the University of Virginia School of Medicine.
The findings, published in the Journal of Oncology Practice, should encourage doctors to better manage mental health in patients with breast cancer. The findings should also encourage healthcare providers to consider alternative pain management options, including physical therapy, massage and acupuncture.
“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,” noted lead researcher Rajesh Balkrishnan, Ph.D, of the Department of Public Health Sciences and the UVA Cancer Center.
“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.”
Breast Cancer and Opioids
Breast cancer kills more than 40,000 people in the United States each year, and patients often suffer from anxiety and depression. Research suggests that about 40 percent of patients with breast cancer have some type of mental health diagnosis.
Balkrishnan and his team set out to shed light on the relationship among mental health, opioid use and breast cancer outcomes. They reviewed more than 10,000 breast cancer cases recorded in the national SEER cancer database, which contains detailed, depersonalized, information on care provided to Medicare beneficiaries with cancer. These cases consisted of women aged 65 years and older who were diagnosed with stage I, II or III breast cancer between January 1, 2006, and December 31, 2012.
The records included in the database sowed that all patients received adjuvant endocrine therapy as treatment.
The researchers sorted the cases into two groups: women with mental health diagnoses and women without such a diagnosis. They found that those with mental health diagnoses had higher opioid use and lower survival rates.
Opioid use is higher in the women with breast cancer who suffer from mental health comorbidities and remains a significant problem, Balkrishnan and his co-authors writes in a new paper outlining their findings.
In their review, Balkrishnan and his team observed that 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).
“In addition, mental health comorbidities also contribute to reduced survival in these women. [There is a major unmet need] for collaborative care in the management of mental health comorbidities in women with breast cancer. [Such cooperation] could improve symptoms, adherence to treatment, and recovery from these mental conditions,” Balkrishan said.
Mental health treatments also are recommended to be offered in primary care, which not only would be convenient for patients but also would reduce the stigma associated with treatments for mental health comorbidities and improve the patient-provider relationship,” he confirmed.
“Complementary forms of treatment for pain, such as physical therapy, cognitive behavioral therapy, acupuncture, acupressure and massage, should be considered, noted Leslie Blackhall, MD, a palliative care expertat UVA.
The researchers noted potential limitations to their study such as a lack of information on the opioids used and a lack of details on the patients’ pain assessments.
They also suggest that mental health conditions such as depression may be underdiagnosed and that, as a result, the research may underestimate the percentage of patients with those conditions.
 Desai R, Camacho F, Tan X, LeBaron V, Blackhall L, Balkrishnan R. Mental Health Comorbidities and Elevated Risk of Opioid Use in Elderly Breast Cancer Survivors Using Adjuvant Endocrine Treatments. J Oncol Pract. 2019 Jul 19:JOP1800781. doi: 10.1200/JOP.18.00781.[Pubmed][Article]