Question: What prompted this research?

Answer: Some of our earlier research focused on adjuvant endocrine therapy use, and we found women who used opioids did not adhere to adjuvant endocrine therapy. This is a very common issue with adjuvant endocrine therapy, a major side effect of which is musculoskeletal spasms. A lot of women who take these medications are required to take them daily, and one of the biggest complaints they have is the muscle spasm pain. Many women cannot even get out of bed because the pain is so bad. Most physicians do not start patients with opioids, but the pain can get so bad that no other drug works other than opioids. The endocrine adjuvant treatment works to prevent subsequent breast cancer in these women and it prolongs survival. When we found that women who use opioids are less likely to adhere to adjuvant treatment, we wanted to explore it further.

Q: What did you find?

A: A lot of women who received prescriptions for opioids did not have a de-escalation plan for issues with abuse and tolerance. When we looked further into the data, we found that women were continuing on opioids for an indefinite amount of time. We found this to be more pronounced among women who lived in rural areas of the United States, as well as minority populations. We additionally confirmed that women who started opioids were more likely to discontinue their endocrine treatment and achieve shorter OS than women who did not take opioids. So, the two major issues we identified were that cancer often is associated with pain — there has not been much work conducted in this area — and that physicians are not de-escalating opioids for women who are breast cancer survivors. I do not know why this is happening. Maybe physicians feel these women have already been through a lot with breast cancer, so they allow them to stay on pain treatment. It also is quite troubling that women who live in rural areas and minority women are more likely to continue on opioids indefinitely, given they most often are seen by primary care physicians and are less likely to receive palliative care or care from oncologists.

See full article at HemoOnctoday.com by Jennifer Southall 

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