New‐onset persistent opioid use following breast cancer treatment in older adult women

Background Patients with cancer‐related pain are underrepresented in the opioid literature despite high opioid exposure and numerous risk factors for adverse opioid outcomes, including unnecessary persistent opioid use. The objective of this study was to determine the extent, historical trends, and predictors of new‐onset persistent opioid use among older adult women after active breast cancer treatment. Methods Using Surveillance, Epidemiology, and End Results–Medicare data for opioid‐naive women diagnosed with stage 0 to III breast cancer at the age of 66 to 90 years between 2008 and 2013, this study estimated overall and quarterly adjusted probabilities of new‐onset persistent opioid use, which was defined as receiving ≥90 days' supply of opioids in the year after active breast cancer treatment. Sensitivity analyses were conducted with an alternative definition of persistent opioid use: any opioid fill 90 to 180 days after active cancer treatment. Results Nearly two‐thirds of the subjects received prescription opioid therapy during cancer treatment. Quarterly probabilities of new‐onset persistent opioid use after active treatment ranged from 2% to 4%; in sensitivity analyses, the alternative outcome definition resulted in predicted probabilities ranging from 11.4% to 14.7%. Subjects with more advanced disease, a higher comorbidity burden, a low‐income status, and greater opioid exposure during active cancer treatment were more likely to develop persistent opioid use. Conclusions Persistent opioid use was an infrequent occurrence among older adult patients with breast cancer completing cancer treatment between 2008 and 2013. This finding was encouraging because of the concerning opioid trends seen in noncancer populations. However, opportunities to further mitigate unsafe opioid use as a complication of cancer care, including standardization of persistent opioid use definitions, should be explored. Since 2008, opioid‐naive older adult women have consistently faced a 3% risk of developing persistent opioid use in the year after the completion of active breast cancer treatment. However, the apparent extent of new‐onset persistent opioid use in early breast cancer survivorship increases dramatically when a common alternative definition of persistent opioid use is used. This necessitates increased scrutiny of how to best measure inappropriate persistent opioid use during cancer survivorship.