Poor Adherence to Hormone Therapy Observed in Breast Cancer Survivors Taking Opioids

Adjuvant endocrine therapy can prevent cancer recurrence but can result in painful side effects.

Findings from a new study suggest patients with breast cancer who take opioids for pain management may have suboptimal adherence to life-saving treatment.

Adjuvant endocrine therapy (hormone therapy) is used to prevent cancer from recurring after surgery, chemotherapy, or radiation; however, opioid use was found to be significantly linked to poor adherence and increased risk of death, according to a study published by Breast Cancer Research and Treatment.

The authors found that patients treated with opioids were found to have “really suboptimal” adherence to hormone therapy.

“It’s not a big secret that the US uses more opioids than any other country in the world,” said researcher Rajesh Balkrishnan, PhD. “Clearly there has to be better management of opioids in the elderly cancer population.”

The researchers said that the opioid epidemic has caused physicians to be overly cautious when prescribing the drugs, despite clinical appropriateness.

“A lot of doctors feel worried about prescribing them,” said researcher Leslie Blackhall, MD. “People feel judged for prescribing them.”

The authors hypothesize that the lack of adherence to hormone therapy may be related to pain associated with the treatment, rather than opioid use, according to the study. Hormone therapy is known to have numerous, painful side effects, which may explain opioid use.

“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,” Dr Blackhall said. “These women switch from 1 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.”

Approximately 60% of breast cancer survivors experience chronic pain resulting from treatment. These individuals may face up to 10 years of hormone therapy to prevent disease recurrence.

The lengthy treatment regimen may make adherence a challenge, especially if pain is not being managed, according to the study.

To better understand the impact of opioid use on hormone therapy, the investigators examined adherence among more than 10,000 women with an average age of 72.

The authors discovered that patients who were younger, single, and had more advanced cancer were more likely to manage pain with opioids, according to the study. Patients with depression were also more likely to use opioids.

Patients who underwent chemotherapy and surgery were more likely to take opioids compared with patients receiving radiation therapy. The authors hypothesize that more targeted radiation may result less pain than other treatment methods, according to the study.

“These results underscore the importance of a balanced approach to the utilization of prescription opioid medications,” said researcher Virginia LeBaron, PhD. “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.”

These findings suggest that approaching breast cancer therapy with more targeted treatments may reduce pain and improve adherence to hormone therapy.

The authors note that additional research is needed to compare pain management techniques for patients with cancer, which may result in optimal medication adherence.

“This study was really just a way to bring attention to the problem and the need to provide better care for patients,” Dr Blackhall concluded.