Abstract 4835: Demographic factors and risk of persistent opioid use in a diverse cohort of breast cancer survivors
Authors: Chen Lie Hong , Hechter Rulin C. , Shi Jiaxiao , Gu Zheng , Brady-Rogers Moira , Chlebowski Rowan T. , Haque Reina 
Published: March 2024

Abstract
Background: Persistent opioid use (POU), in breast cancer survivors after they have completed active cancer treatment is an emerging area of concern. We examined rates and identified risk with POU in breast cancers survivors in the year after active cancer treatment going forward, and if these risks differed by race/ethnicity.
Methods: We assembled a cohort of female breast cancer survivors diagnosed in 2009-2019 treated for early-stage disease (in situ, local, regional), and had at least two opioid prescriptions after one year of survivorship in a large health plan in southern California. Data were captured from the tumor registry, electronic health records, and pharmacy databases. The primary outcome was POU defined as continuously receiving at least 90 days supplied of opioids during follow-up. Patients were followed through the date once they met POU criteria, died, disenrolled from health plan, or reached study’s end (12/31/2021), whichever came first. We calculated rates as the number of patients who experienced POU per 1,000 person-years (PY). We identified the predictors and estimated hazard ratios (HR) associated with POU using multivariable proportional hazard regression and stratified by race/ethnicity.
Results: The cohort included 14,347 breast cancer survivors who used opioids followed for a maximum of 12 years (median: 6.6 years). Overall, the cohort was diverse: 9% Asian/Pacific Islander (API); 14% Black; 22% Hispanic; and 54% White women. Out of 14,347 patients who used opioids, 2,285 (16%) patients developed POU. POU rates was the highest in Whites (36.2 per 1,000 PY) compared other race/ethnicity groups including Blacks, Hispanics, APIs (30.7, 17.3, 10.6 per 1,000 PY, respectively). Patients who developed POU had longer annualized median opioid duration, especially in Black patients (175.0 vs. 5.3 days) and were prescribed stronger opioids (median maximum daily morphine milligram equivalent 83.7 vs 50.0), compared to those who did not develop POU. In adjusted analyses of POU risk, Black (HR, 0.81; 95% CI: 0.72-0.92), API (HR, 0.59; 95% CI, 0.52-0.66), and Hispanic women (HR, 0.59; 95% CI, 0.52-0.66) were less likely to develop POU compared to White women. Patients with older age, Elixhauser Comorbidity Index ≥3, smoking, breast cancer stage (regional); type of opioid (Oxycodone); and who used other psychiatric and pain medications had significantly greater POU risk. In stratified analysis, the POU risk was 2.6 times greater (HR, 2.61; 95% CI, 1.32-5.15) in Hispanic patients aged≥65 vs &lt;40 years. The highest HR was in APIs who were current smokers (HR, 4.26; 95% CI, 1.77-10.29) compared with non-smokers.
Conclusion: The findings suggest that patients who are older, current smokers, with more comorbidities, and diagnosed with higher cancer stage were most vulnerable to developing POU.
Citation Format: Lie Hong Chen, Rulin C. Hechter, Jiaxiao Shi, Zheng Gu, Moira Brady-Rogers, Rowan T. Chlebowski, Reina Haque. Demographic factors and risk of persistent opioid use in a diverse cohort of breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4835.