DOES LONG-TERM EXPOSURE TO OPIOID LEAD TO HIGHER RISK OF BREAST CANCER RECURRENCE? AN OBSERVATIONAL STUDY USING U.S. POPULATION DATA
Author(s)
Albert M. Truong, PharmD1, Livingstone Aduse-Poku, PhD1, Susan Hong, MD, MPH1, Renato Martins, MD1, Frederick G. Moeller, MD1, Vasco M. Pontinha, MA, MSc, PhD2;
1Virginia Commonwealth University, Richmond, VA, USA, 2Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
1Virginia Commonwealth University, Richmond, VA, USA, 2Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
OBJECTIVES: The evidence examining the link between opioid exposure and cancer recurrence is contradictory and marred by methodological biases, like time and quantification of exposure, and survivorship definition. To address these limitations, we designed an observational study to evaluate the association between long-term opioid exposure and cancer recurrence in disease-free breast cancer survivors.
METHODS: Using MarketScan, we identified a cohort of disease-free breast cancer survivors. Patients were followed since date of last treatment. Opioid exposure was quantified based on duration and dose intensity. Time to recurrence was evaluated using extended Cox models, assuming time-varying exposure and covariates. Models were adjusted for several sociodemographic and clinical covariates.
RESULTS: In the overall model, each 1-unit increase in opioid exposure was associated with a lower hazard of recurrence at the disease-free index (HR: 0.95; 95% CI: 0.95-0.96), but this association increased over time into higher recurrence risk with longer follow-up. (HR: 1.01; 95% CI: 1.006-1.008). When patients were grouped in quartiles (Q1-least exposed to Q4-most exposed), all groups were associated with lower hazards of recurrence early in follow-up (HR range: 0.0034-0.0738), but significantly higher with longer follow-up. Each group exhibited a significant increase in recurrence risk over time: HRQuartile1=2.25 (95% CI: 2.12-2.40), HRQuartile2=2.04 (95% CI: 1.95-2.13), HRQuartile3=1.69 (95% CI: 1.63-1.76), and HRQuartile4=1.59 (95% CI: 1.51-1.67). Generally, duration and intensity of opioid exposure is associated with a shorter time to event and higher risk of recurrence in breast cancer disease-free survivors.
CONCLUSIONS: The present study is one of the few observational studies with longer follow-up examining the link between opioid risk exposure and cancer recurrence. In breast cancer disease free survivors, our results describe the time-varying nature of the risk of recurrence, that seems to be dose and duration dependent. Additionally, our results may help explain the concurring results from previous research.
METHODS: Using MarketScan, we identified a cohort of disease-free breast cancer survivors. Patients were followed since date of last treatment. Opioid exposure was quantified based on duration and dose intensity. Time to recurrence was evaluated using extended Cox models, assuming time-varying exposure and covariates. Models were adjusted for several sociodemographic and clinical covariates.
RESULTS: In the overall model, each 1-unit increase in opioid exposure was associated with a lower hazard of recurrence at the disease-free index (HR: 0.95; 95% CI: 0.95-0.96), but this association increased over time into higher recurrence risk with longer follow-up. (HR: 1.01; 95% CI: 1.006-1.008). When patients were grouped in quartiles (Q1-least exposed to Q4-most exposed), all groups were associated with lower hazards of recurrence early in follow-up (HR range: 0.0034-0.0738), but significantly higher with longer follow-up. Each group exhibited a significant increase in recurrence risk over time: HRQuartile1=2.25 (95% CI: 2.12-2.40), HRQuartile2=2.04 (95% CI: 1.95-2.13), HRQuartile3=1.69 (95% CI: 1.63-1.76), and HRQuartile4=1.59 (95% CI: 1.51-1.67). Generally, duration and intensity of opioid exposure is associated with a shorter time to event and higher risk of recurrence in breast cancer disease-free survivors.
CONCLUSIONS: The present study is one of the few observational studies with longer follow-up examining the link between opioid risk exposure and cancer recurrence. In breast cancer disease free survivors, our results describe the time-varying nature of the risk of recurrence, that seems to be dose and duration dependent. Additionally, our results may help explain the concurring results from previous research.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO62
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Injury & Trauma, SDC: Oncology