Persistent prescription opioid use and all-cause mortality following the first-year breast cancer survivorship
Menée à partir de données 2009-2019 portant sur 14 347 patientes ayant survécu à un cancer du sein non métastatique, cette étude de cohorte rétrospective analyse les prescriptions d'opioïdes plus d'un an après la fin des traitements et évalue l'effet de ces prescriptions sur la mortalité
Background: Harm associated with persistent opioid use beyond the first-year intensive cancer treatment is under-investigated in cancer survivors. We examined rates and risk factors for persistent opioid use and all-cause mortality after the first-year breast cancer survivorship.
Methods: This retrospective cohort study used electronic health record data from Kaiser Permanente Southern California for women diagnosed with a non-metastatic breast cancer between 2009-2019 who filled two or more opioid prescriptions. Rates of persistent opioid use were estimated from first-year survivorship through December 31, 2021. Rate ratios (RR) and 95% confidence intervals (CI) for factors associated with persistent use were estimated using a multivariable Poisson regression model. Hazard ratios (HR) for all-cause mortality associated with persistent opioid use were estimated using multivariable Cox regression models.
Results: Of 14,347 eligible individuals (mean [SD] age, 61.9 [12.5]), 2,285 (15.9%) developed persistent opioid use, with an incident rate of 25.5 per 1000 person-years. Risk factors included older age (
≥
65 vs < 65 years: RR, 1.63 [95% CI, 1.24-2.14]), smoking (current: 1.89 [1.68- 2.13]; former: 1.30 [1.20-1.41]), baseline comorbidities (Elixhauser Comorbidity Index 5+ vs 0: 1.70 [1.29- 2.24]) and substance use disorders (1.58 [1.43- 1.74]). All-cause mortality was doubled among individuals with persistent use (51.6 [48.0-55.6] per 1000 person-years) than in those without (25.3 [24.2-26.4]). Persistent use was associated with an increased all-cause mortality (aHR:1.84 [1.66-2.04]).
Conclusions: Persistent opioid use was common in breast cancer survivors and associated with increased mortality. Further research is needed to explore factors that may be contributing to increased mortality.
JNCI Cancer Spectrum , résumé, 2025