scholarly journals New Persistent Opioid and Benzodiazepine Use After Curative-Intent Treatment in Patients With Breast Cancer

2021 ◽  
Vol 19 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Mandy R. Sakamoto ◽  
Megan Eguchi ◽  
Christine M. Azelby ◽  
Jennifer R. Diamond ◽  
Christine M. Fisher ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Population Based ◽  
Opioid Use ◽  
Curative Intent ◽  
Patients With Cancer ◽  
Healthcare Crisis ◽  
Benzodiazepine Use ◽  
Use Factors

Background: Opioid and benzodiazepine use and abuse is a national healthcare crisis to which patients with cancer are particularly vulnerable. Long-term use and risk factors for opioid and benzodiazepine use in patients with breast cancer is poorly characterized. Methods: We conducted a retrospective population-based study of patients with breast cancer diagnosed between 2008 and 2015 undergoing curative-intent treatment identified through the SEER-Medicare linked database. Primary outcomes were new persistent opioid use and new persistent benzodiazepine use. Factors associated with new opioid and benzodiazepine use were investigated by univariate and multivariable logistic regression. Results: Among opioid-naïve patients, new opioid use was observed in 22,418 (67.4%). Of this group, 611 (2.7%) developed persistent opioid use at 3 months and 157 (0.7%) at 6 months after treatment. Risk factors for persistent use at 3 and 6 months included stage III disease (odds ratio [OR], 2.16; 95% CI, 1.49–3.12, and OR, 3.48; 95% CI, 1.58–7.67), surgery plus chemotherapy (OR, 1.44; 95% CI, 1.10–1.88, and OR, 2.28; 95% CI, 1.40–3.71), surgery plus chemoradiation therapy (OR, 1.47; 95% CI, 1.10–1.96, and OR, 2.34; 95% CI, 1.38–3.96), and initial tramadol use (OR, 2.66; 95% CI, 2.05–3.46, and OR, 3.12; 95% CI, 1.93–5.04). Among benzodiazepine-naïve patients, new benzodiazepine use was observed in 955 (10.3%), and 111 (11.6%) developed new persistent use at 3 months. Tamoxifen use was statistically significantly associated with new persistent benzodiazepine use at 3 months. Conclusions: A large percentage of patients receiving curative-intent treatment of breast cancer were prescribed new opioids; however, only a small number developed new persistent opioid use. In contrast, a smaller proportion of patients received a new benzodiazepine prescription; however, new persistent use after completion of treatment was more likely and particularly related to concurrent treatment with tamoxifen.

scholarly journals New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery

2017 ◽  
Vol 35 (36) ◽  
pp. 4042-4049 ◽  
Author(s):  
Jay Soong-Jin Lee ◽  
Hsou Mei Hu ◽  
Anthony L. Edelman ◽  
Chad M. Brummett ◽  
Michael J. Englesbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Prescription Opioid ◽  
Patient Counseling ◽  
Opioid Use ◽  
Curative Intent ◽  
Data Set ◽  
Opioid Dose ◽  
Adjusted Risk ◽  
Patients With Cancer

Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014. We included melanoma, breast, colorectal, lung, esophageal, and hepato-pancreato-biliary/gastric cancer. Primary outcomes were new persistent opioid use (opioid-naïve patients who continued filling opioid prescriptions 90 to 180 days after surgery) and daily opioid dose (evaluated monthly during the year after surgery). Logistic regression was used to identify risk factors for new persistent opioid use. Results A total of 68,463 eligible patients underwent curative-intent surgery and filled opioid prescriptions. Among opioid-naïve patients, the risk of new persistent opioid use was 10.4% (95% CI, 10.1% to 10.7%). One year after surgery, these patients continued filling prescriptions with daily doses similar to chronic opioid users ( P = .05), equivalent to six tablets per day of 5-mg hydrocodone. Those receiving adjuvant chemotherapy had modestly higher doses ( P = .002), but patients with no chemotherapy still had doses equivalent to five tablets per day of 5-mg hydrocodone. Across different procedures, the covariate-adjusted risk of new persistent opioid use in patients receiving adjuvant chemotherapy was 15% to 21%, compared with 7% to 11% for those with no chemotherapy. Conclusion New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.

scholarly journals Symposium report: breast cancer in India—trends, environmental exposures and clinical implications

2021 ◽  
Vol 32 (6) ◽  
pp. 567-575
Author(s):  
Jasmine A. McDonald ◽  
Roshni Rao ◽  
Marley Gibbons ◽  
Rajiv Janardhanan ◽  
Surinder Jaswal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Environmental Exposures ◽  
Population Based ◽  
Clinical Implications ◽  
Think Tank ◽  
Case Control Studies ◽  
Short Term

Abstract Purpose Incidence of breast cancer (BC), particularly in young women, are rising in India. Without population-based mammography screening, rising rates cannot be attributed to screening. Investigations are needed to understand the potential drivers of this trend. Methods An international team of experts convened to discuss the trends, environmental exposures, and clinical implications associated with BC in India and outlined recommendations for its management. Results Panels were structured across three major BC themes (n = 10 presentations). The symposium concluded with a semi-structured Think Tank designed to elicit short-term and long-term goals that could address the challenges of BC in India. Conclusion There was consensus that the prevalence of late-stage BC and the high BC mortality rates are associated with the practice of detection, which is primarily through clinical and self-breast exams, as opposed to mammography. Triple-Negative BC (TNBC) was extensively discussed, including TNBC etiology and potential risk factors, the limited treatment options, and if reported TNBC rates are supported by rigorous scientific evidence. The Think Tank session yielded long-term and short-term goals to further BC reduction in India and included more regional etiological studies on environmental exposures using existing India-based cohorts and case–control studies, standardization for molecular subtyping of BC cases, and improving the public’s awareness of breast health.

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery.MethodsA nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010.ResultsThe study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010.ConclusionsThe findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.

scholarly journals Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1303
Author(s):  
Khairunnisa’ Md Yusof ◽  
Kelly A. Avery-Kiejda ◽  
Shafinah Ahmad Suhaimi ◽  
Najwa Ahmad Zamri ◽  
Muhammad Ehsan Fitri Rusli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Survivors ◽  
Potential Risk ◽  
Breast Cancer Survivors ◽  
Ultrasound Examination ◽  
Arm Circumference ◽  
Potential Risk Factors ◽  
Breast Cancer Related Lymphedema

Breast cancer has been reported to have the highest survival rate among various cancers. However, breast cancer survivors face several challenges following breast cancer treatment including breast cancer-related lymphedema (BCRL), sexual dysfunction, and psychological distress. This study aimed to investigate the potential risk factors of BCRL in long term breast cancer survivors. A total of 160 female breast cancer subjects were recruited on a voluntary basis and arm lymphedema was assessed through self-reporting of diagnosis, arm circumference measurement, and ultrasound examination. A total of 33/160 or 20.5% of the women developed BCRL with significantly higher scores for upper extremity disability (37.14 ± 18.90 vs. 20.08 ± 15.29, p < 0.001) and a lower score for quality of life (103.91 ± 21.80 vs. 115.49 ± 16.80, p = 0.009) as compared to non-lymphedema cases. Univariate analysis revealed that multiple surgeries (OR = 5.70, 95% CI: 1.21–26.8, p < 0.001), axillary lymph nodes excision (>10) (OR = 2.83, 95% CI: 0.94–8.11, p = 0.047), being overweight (≥25 kg/m2) (OR = 2.57, 95% CI: 1.04 – 6.38, p = 0.036), received fewer post-surgery rehabilitation treatment (OR = 2.37, 95% CI: 1.05–5.39, p = 0.036) and hypertension (OR = 2.38, 95% CI: 1.01–5.62, p = 0.043) were associated with an increased risk of BCRL. Meanwhile, multivariate analysis showed that multiple surgeries remained significant and elevated the likelihood of BCRL (OR = 5.83, 95% CI: 1.14–29.78, p = 0.034). Arm swelling was more prominent in the forearm area demonstrated by the highest difference of arm circumference measurement when compared to the upper arm (2.07 ± 2.48 vs. 1.34 ± 1.91 cm, p < 0.001). The total of skinfold thickness of the affected forearm was also significantly higher than the unaffected arms (p < 0.05) as evidenced by the ultrasound examination. The continuous search for risk factors in specific populations may facilitate the development of a standardized method to reduce the occurrence of BCRL and provide better management for breast cancer patients.

Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors

2015 ◽  
Vol 9 (3) ◽  
pp. 422-430 ◽  
Author(s):  
Nandita Das ◽  
Richard N. Baumgartner ◽  
Elizabeth C. Riley ◽  
Christina M. Pinkston ◽  
Dongyan Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Related Risk ◽  
Arm Lymphedema

The Global Burden of Breast Cancer in Women

2019 ◽  
pp. 3-16
Author(s):  
Isabelle Soerjomataram ◽  
Claudia Allemani ◽  
Adri Voogd ◽  
Sabine Siesling
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Cancer Incidence ◽  
Cancer Control ◽  
Population Based ◽  
High Income ◽  
Cancer Risk Factors ◽  
Consequent Reduction ◽  
Breast Cancer Risk Factors ◽  
Sub Saharan

Abstract: Breast cancer is the most frequently diagnosed cancer and the leading cause of death from cancer in women. The number of women diagnosed with breast cancer world-wide is projected to increase from an estimated 1.7 million per year in 2012 to 2.2 million new cases per year by 2035. The largest component of this increase relates to demographic change (increasing and ageing populations), changes in breast cancer risk factors linked to westernization, and adoption of unhealthy lifestyles. Although major successes have been observed in improving survival from breast cancer, with a consequent reduction in mortality, these gains have mainly been observed in high-income countries. The international range in population-based survival also remains wide: the most recent 5-year net survival estimates range from <60% in some regions of sub-Saharan Africa to >85% in many high-income countries. These disparities are undoubtedly linked to inadequate access to diagnostic and treatment facilities in low-resource regions, where the number of women being diagnosed each year is still increasing and breast cancer is becoming an urgent problem. Tackling the growing burden of breast cancer will require comprehensive programmes of cancer control, with primary prevention, screening, and treatment tailored to local risk factors and health system capacities. Ongoing global initiatives on breast cancer have developed resource-stratified guidelines to promote early detection and treatment that meet the local cultural and economic situation. Wider adoption and quality assurance of such programmes will be key to reducing the observed global disparities in breast cancer incidence and survival.

scholarly journals Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Yi J Zhang ◽  
Martin N Stienen ◽  
Daniel Vail ◽  
Jason Bentley ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Medical Community ◽  
National Database ◽  
Low Back ◽  
Newly Diagnosed ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Lower Extremity Pain ◽  
Benzodiazepine Use

Abstract INTRODUCTION The morbidity and mortality associated with opioid and benzodiazepine co-prescribing is a pressing national concern. The aim of this work was to characterize patterns of opioid and benzodiazepine prescribing among opioid-naïve, newly-diagnosed low back and lower extremity pain patients and to investigate the relationship between benzodiazepine prescribing and long-term opioid use. METHODS We used a national database to identify adult patients newly diagnosed with low back pain (LBP) between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. Among patients receiving at least 1 opioid prescription within 12 mo of diagnosis, we defined discrete patterns of benzodiazepine prescribing continued use, new use, stopped use, and never use. We tested the association of these prescription patterns with long-term opioid use, defined as 6or more fills within 12 mo. RESULTS We identified 2 497 653 opioid-naïve patients with newly diagnosed LBP or lower extremity pain. Between 2008 and 2015, 31.9% and 11.5% of these patients received opioid and benzodiazepine prescriptions, respectively, within 12 mo of diagnosis. Rates of opioid prescription decreased from 34.8% in 2008 to 27.0% in 2015; however, prescribing of benzodiazepines was unchanged (2008, 11.6%; 2015, 10.8%). Patients with continued or new benzodiazepine use consistently used more opioids than patients who never used or stopped using benzodiazepines during the study period (one-way ANOVA, P < .0001). For patients with continued and new benzodiazepine use, the odds ratio of long-term opioid use compared to those never prescribed a benzodiazepine was 2.99 (95% CI, 2.89-3.08) and 2.68 (95% CI, 2.62-2.75), respectively. CONCLUSION Overall opioid prescribing for LBP decreased substantially during the study period, indicating a shift in management within the medical community. Rates of benzodiazepine prescribing, however, remained unchanged. Patterns of benzodiazepine prescribing were associated with long-term opioid use.

scholarly journals Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

BMJ ◽  
2020 ◽  
pp. m1570 ◽  
Author(s):  
Gurdeep S Mannu ◽  
Zhe Wang ◽  
John Broggio ◽  
Jackie Charman ◽  
Shan Cheung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Breast Screening ◽  
Ductal Carcinoma ◽  
Breast Cancer Mortality ◽  
Population Based ◽  
Breast Screening Programme ◽  
Observational Cohort

AbstractObjectiveTo evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening.DesignPopulation based observational cohort study.SettingData from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service.ParticipantsAll 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014.Main outcome measuresIncident invasive breast cancer and death from breast cancer.ResultsBy December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer.ConclusionsTo date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

Sign in / Sign up

Export Citation Format

Share Document