Abstract GS3-08: Persistent controlled substance use following mastectomy with reconstruction surgery

Abstract

Abstract Introduction Cancer surgery has been linked to chronic opioid use post-operatively, with up to 10% of patients continuing to fill opioid prescriptions beyond 3 months after surgery. However, previous studies have not compared post-operative opioid use between those with and without a diagnosis of cancer. Furthermore, it is unknown if a similar pattern exists regarding the use of benzodiazepines (benzos) and other non-benzo sedative/hypnotics (N-benzos) after mastectomy and reconstruction (M+R). Methods We used the MarketScan healthcare claims database to evaluate women >18 years of age who underwent M+R between the years 2008-2017. We identified prescriptions for opioids, benzos and N-benzos during three periods: 365 days to 31 days prior to surgery (period 1); 31 days prior to 90 days after their surgery (period 2); and 90 days to 365 days after surgery (period 3). Patients who used controlled substances prior to surgery (i.e. who filled at least one prescription for a given agent during period 1) were excluded from the analysis. Patients who had no use in period 1 but filled at least one prescription in period 2 and at least two prescriptions in period 3 were considered new chronic users, and were compared to the other non-chronic users. A separate multivariable logistic regression analysis was used to evaluate demographic and clinical factors associated with risk of chronic use for each drug category. Results We identified cohorts of women who underwent M+R and were not prior users of opioids (n=26,264), benzos (n=29,163) or N-benzos (n=34,388). Within each of these groups, 12.1% became new chronic users of opioids after M+R, 5.3% became new chronic users of benzos and 2.6% became new chronic users of N-benzos. Higher rates of new chronic opioid use were seen in younger patients, those with Medicaid insurance (OR=1.37, p=.003), those with a diagnosis of breast cancer (OR=1.45; p=.03), receipt of chemotherapy (OR=1.35, p<.0001), mental health diagnoses (OR=1.66, p<.0001) and substance use diagnoses (OR=1.93, p<.0001). Similar results were seen with the other drug categories (Table 1). Conclusion Among women who underwent M+R, those with a diagnosis of breast cancer, those who received chemotherapy and those who were younger had a higher risk of new chronic controlled substance use. Particular attention should be paid to patients with mental health diagnoses and substance use diagnoses when managing pain, anxiety and sleep disorders. Multivariable analysis of factors associated with new chronic controlled substance useVariableSub-groupNew chronic opioid users (%)Odds ratio (95% CI)p valueNew chronic benzo users (%)Odds ratio (95% CI)p valueNew chronic N-benzo users (%)Odds ratio (95% CI)p valueAge<=39 years12.91.63 (1.26-2.11)0.00026.41.67 (1.14-2.44)0.0092.61.77 (1.02-3.07)0.0440-69 years12.21.60 (1.27-2.02)<0.00015.31.58 (1.11-2.25)0.012.62.00 (1.19-3.34)0.009>=70 years7.3Referent2.8Referent1.1ReferentInsuranceMedicaid19.51.37 (1.11-1.68)0.00310.41.30 (1.02-1.66)0.043.71.05 (0.74-1.48)0.8Commercial/Medicare11.9Referent5.2Referent2.5ReferentBreast cancer diagnosisYes12.11.45 (1.04-2.02)0.035.41.82 (1.06-3.13)0.032.61.50 (0.77-2.93)0.2No7.8Referent2.1Referent1.3ReferentChemotherapy treatmentYes14.21.35 (1.25-1.46)<0.00017.92.20 (1.98-2.45)<0.00013.61.92 (1.68-2.21)<0.0001No10.6Referent3.5Referent1.8ReferentMental health diagnosisYes15.51.66 (1.54-1.79)<0.00019.53.78 (3.37-4.24)<0.00013.82.22 (1.93-2.56)<0.0001No9.4Referent2.5Referent1.6ReferentSubstance use diagnosisYes23.61.93 (1.64-2.26)<0.000111.61.62 (1.32-1.98)<0.00014.91.58 (1.22-2.04)0.0005No11.6Referent5.1Referent2.5Referent Citation Format: Jacob C Cogan, Rohit R Raghunathan, Melissa P Beauchemin, Melissa K Accordino, Alexander Melamed, Jason D Wright, Dawn L Hershman. Persistent controlled substance use following mastectomy with reconstruction surgery [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS3-08.