A large number of breast cancer patients suffer from chronic pain related to treatment. In fact, many survivors face about 10 years of adjuvant endocrine therapy — commonly referred to as hormone therapy — just to keep the cancer from returning. And while this treatment is well-known for its negative side effects, it is considered vital to the survival of many patients.
Now a new study, published in the journal Breast Cancer Research and Treatment, has found that patients who take opioids to manage their pain levels are much less likely to adhere to this preventative therapy and also face a higher risk of death. The reasons for this, however, are still unclear.
Researcher Leslie Blackhall, M.D., a pain-management expert at the UVA Health System suggests that this lack of adherence to the adjuvant endocrine therapy may be due to the pain involved in the therapy itself, rather than because of the opioid use. The pain, she said, is why the patients need powerful opioids in the first place.
“The main problem is that these hormonal medications … have so many side effects that women do not want to take them. They can cause really severe joint and muscle pain in a significant number of women,” Blackhall said.
“These women switch from one agent to the other but still can’t tolerate them. They are then given opioids for the pain, which may or may not help. The opioids may themselves add to the mortality, but we don’t know. More data is needed.”
Blackhall noted that the article is intended to foster dialogue and to encourage more research on the subject. For example, clinical trials might compare opioids with non-opioids for managing cancer pain or identify patient subgroups that would most benefit from certain approaches to pain management.
“This study was really just a way to bring attention to the problem and the need to provide better care for patients,” she said.
To better understand the association between opioid use and the hormone therapy, the researchers looked at treatment adherence among more than 10,000 women, with an average age of 72.3, using the National Cancer Institute’s expansive SEER database. They found that women who were younger, single and had more advanced cancer were more likely to be on opioids, as were women with depression.
In terms of cancer treatments, women who were receiving chemotherapy and breast cancer surgery were more likely to take opioids, while those receiving radiation therapy were somewhat less likely to take opioids. This may be because of new, more targeted radiation therapy that is less painful overall, the researchers hypothesized.
“These results underscore the importance of a balanced approach to the utilization of prescription opioid medications,” said Virginia LeBaron, Ph.D., of the UVA School of Nursing, a former medical oncology staff nurse and palliative care nurse practitioner.
“By balanced approach, I mean that it is critically important we ensure that prescription opioid medications are accessible to cancer patients who need them, but at the same time we must ensure we have appropriate systems in place to mitigate risk and reduce potential harms related to these medications.”