Abstract PD5-08: New and persistent sedative hypnotic use after adjuvant chemotherapy for breast cancer

Abstract

Abstract Introduction: Sedative-hypnotic medications, such as benzodiazepines (BZDs) and non-benzodiazepine sedative-hypnotics (Z-drugs), are used to treat chemotherapy-related nausea, anxiety and insomnia. While effective for these indications, prolonged use can lead to dependence, misuse and increased healthcare utilization. We aimed to estimate rates of new and persistent BZD and Z-drug use after adjuvant chemotherapy for breast cancer. Methods: We used the MarketScan health care claims database to identify patients who received adjuvant chemotherapy for breast cancer from 2008 to 2017. We categorized prescriptions for BZDs or Z-drugs into three periods: 365 days prior to chemotherapy to the start of chemotherapy (period 1); start of chemotherapy to 90 days after the end of chemotherapy (period 2); and 90 days to 365 days after chemotherapy (period 3). Patients who filled no BZD prescriptions in period 1 were considered BZD-naïve. Those who then filled at least one BZD prescription in period 2, and at least two BZD prescriptions in period 3, were classified as new persistent BZD users. The same definitions were used for Z-drugs. We used multivariable logistic regression to estimate associations between patient characteristics and new persistent use of BZDs and Z-drugs. Results: We identified 17,532 BZD-naïve patients and 21,863 Z-drug-naïve patients who received adjuvant chemotherapy for breast cancer. The median age was 57 for BZD-naïve patients (IQR = 13) and 56 for Z-drug-naïve patients (IQR = 13). The majority of patients had commercial or Medicare insurance (92.6% BZD-naïve, 92.7% Z-drug-naïve) versus Medicaid. A slight majority received lumpectomy (56.6% BZD-naïve, 55.1% Z-drug-naïve) versus mastectomy. Roughly half of patients received less than 4 months of chemotherapy (48.0% BZD-naïve, 48.6% Z-drug-naïve). Among BZD-naïve patients, 4,447 (25%) filled at least one BZD prescription during chemotherapy, and 1,192 (7% of all BZD-naïve patients, 27% of those filling at least one BZD prescription during chemotherapy) became new persistent BZD users after chemotherapy. Among Z-drug naïve patients, 2,160 (10%) filled at least one Z-drug prescription during chemotherapy, and 730 (3% of all Z-drug-naïve patients, 34% of those filling at least one prescription during chemotherapy) became new persistent Z-drug users afterwards. There were 115 patients who became new persistent users of both types of sedative-hypnotics. Several characteristics were associated with new persistent BZD use: age 50-65 (Table 1; OR = 1.23, p = 0.01) and age > 65 (OR = 1.38, p = 0.005) relative to age ≤ 49; as well as Medicaid insurance, relative to commercial and Medicare insurance (OR = 1.68, p < 0.0001). Chemotherapy duration of less than 4 months was associated with both new persistent BZD and Z-drug use relative to 4 or more months of chemotherapy (OR = 1.17, p = 0.03 for BZDs; OR = 1.58, p < 0.0001 for Z-drugs). Conclusion: Women who receive sedative-hypnotic medications during adjuvant chemotherapy for breast cancer are at risk of becoming persistent users of these medications after chemotherapy. With an awareness of this observation, providers can take steps to ensure appropriate use of these medications, through tapering dosages and encouraging non-pharmacologic strategies when appropriate. Associations between Patient Characteristics and New Persistent Sedative-Hypnotic UseNew Persistent BZD UseNew Persistent Z-Drug UseVariableOdds Ratio95% CIp valueOdds Ratio95% CIp valueAge (years)≤ 49ReferentReferent50-651.231.05 - 1.430.011.210.99 - 1.480.07> 651.381.10 - 1.720.0050.950.68 - 1.310.7InsuranceMedicaid1.681.31 - 2.16<0.00010.760.50 - 1.150.2OtherReferentReferentSurgeryMastectomy1.090.95 - 1.250.20.890.74 - 1.070.2LumpectomyReferentReferentChemotherapy duration< 4 months1.171.02 - 1.340.031.581.31 - 1.89<0.0001≥ 4 monthsReferentReferent Citation Format: Jacob C. Cogan, Rohit R. Raghunathan, Melissa P. Beauchemin, Melissa K. Accordino, Elena B. Elkin, Alexander Melamed, Jason D. Wright, Dawn L. Hershman. New and persistent sedative hypnotic use after adjuvant chemotherapy for breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-08.