Older breast cancer patients who also struggle with anxiety, depression or other mental health conditions are more likely to use opioids and are at greater risk of death, according to a new study led by the University of Virginia School of Medicine.
The findings should encourage clinicians to better manage their patients’ mental health and to consider alternative pain management options such as physical therapy, massage and acupuncture, say the researchers.
“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,” said 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 is linked to more than 40,000 deaths in the United States each year, and these 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.
For the study, the researchers reviewed more than 10,000 breast cancer cases recorded in the national SEER cancer database, which contains detailed (but non-personalized) information on care provided to Medicare beneficiaries with cancer.
These cases consisted of women, ages 65 years and older, who were diagnosed with stage I, II or III breast cancer between Jan. 1, 2006, and Dec. 31, 2012. All received adjuvant endocrine therapy as treatment.
The researchers sorted the cases into two groups: women with mental health diagnoses and those without. 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,” the researchers write in a new paper outlining their findings.
“In addition, mental health comorbidities also contribute to reduced survival in these women. A need exists for collaborative care in the management of mental health comorbidities in women with breast cancer, which could improve symptoms, adherence to treatment, and recovery from these mental conditions.”
“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 ith treatments for mental health comorbidities and improve the patient-provider relationship.”
The researchers, including UVA palliative care expert Leslie Blackhall, M.D., recommend that doctors and other care providers consider “complementary forms of treatment for pain,” such as physical therapy, cognitive behavioral therapy, acupuncture, acupressure and massage.
The findings are published in the Journal of Oncology Practice.