Addressing the Psychosocial Needs in Older Breast Cancer Patients

A study conducted in Canada to estimate the prevalence of psychotropic and opioid medication use by older women diagnosed with breast cancer found a significant increase in use, especially during the active treatment phase. Antidepressant use, on the other hand, persisted through active treatment and into survivorship.

Breast cancer diagnosis is more common in older women, who usually present with comorbidities and associated polypharmacy. Further, age-related cognitive decline and greater susceptibility to adverse reactions from cancer-related treatments could be a source of anxiety and distress in this patient population. To complicate matters, studies have shown that antidepressant medications could interfere with the efficacy of breast cancer treatments like tamoxifen. With this in mind, the authors conducted the present study, the results of which have been published in the Journal of the National Comprehensive Cancer Network, to understand pharmacologic management of distress and pain in this high-risk group of patients.

The study followed 19,353 women over age 65 who were diagnosed with incident, nonmetastatic breast cancer in Quebec, Canada. Health data were sourced from provincial, universal health, and drug insurance plans. Psychotropic and opioid medication use was assessed across the care trajectory, from the precancer stage until the first year of survivorship.

A significant increase in medication use was observed from the precancer stage into active treatment, followed by a drop in use during the first year of survivorship. Anxiolytics, the authors write, were more commonly used across the care trajectory by the studied patient population—36.3% at baseline, 50.6% during active treatment, and 44.4% during survivorship. Antipsychotic and opioid medications saw a spike in utilization during the active treatment phase: a 4.5- and 7-fold increase compared with baseline. Antidepressant use, however, peaked during the active phase (22.4%, up from 14.7% at baseline) and then was sustained during survivorship (22.3%).

Accounting for the fact that these older women who were receiving treatment for their cancer experienced distress and pain across their care trajectory, and the risk of drug-drug interactions leading to adverse events, the authors recommend integrating psychological interventions in the treatment plan to address these women’s needs.

Reference

Syrowatka A, Chang SL, Tamblyn R, Mayo NE, Meguerditchian AN. Psychotropic and opioid medication use in older patients with breast cancer across the care trajectory: a population-based cohort study. J Natl Compr Canc Netw. 2016;14(11):1412-1419.