Department of Research & Evaluation News

Breast cancer survivors commonly continue to use opioid pain killers after their cancer treatment is complete. A new Kaiser Permanente study shows that this can increase their risk of falls and bone fractures, lung problems, and cardiovascular conditions.

The study was published in October 2024 in The Oncologist.

A cancer epidemiologist partnered with a breast cancer survivor to lead the study.

“My research focuses on cancer survivorship, not just cancer outcomes but how well people are doing after they survive breast cancer,” explained lead author Reina Haque, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. “This research came about after a discussion with Moira Brady-Rogers, a breast cancer survivor and licensed marriage and family therapist. She and I were talking about the many facets of breast cancer survivorship and we realized that use of opioids for chronic pain and the outcomes is a very understudied topic.”

Moira Brady-Rogers, MA, LMFT, who is also a Duke Integrative Medicine–certified health coach, said her passion for research is fueled by 32 years of navigating her own health challenges since her initial diagnosis at 30 years old and working with other breast cancer survivors, “I’ve experienced and witnessed the ways breast cancer continues to affect our lives even after treatment is complete.”

In this study looking at the lives of breast cancer survivors, researchers assessed electronic health records from 2009 to 2019 and matched 33,989 breast cancer survivors with 157,609 women of the same ages with no history of cancer.

It showed that 11% of breast cancer survivors had persistent use of opioids in the years following active treatment. This suggests opioid use occurs well beyond active cancer treatment. The investigators also found opioid use among breast cancer survivors was associated with:

• 74% increased risk for falls
• 110% increased risk for fractures
• 70% increased risk of cardiovascular events, such as heart attacks
• 53% increased risk of lung problems, such as chronic obstructive pulmonary disease and pneumonia

The risk of these conditions was higher in breast cancer survivors when compared with the matched cohort without cancer

Dr. Haque suggested that the higher risk of falls and fractures may also be partly due to some hormonal breast cancer treatments that can affect bone health. The research did not assess opioid use disorder or overdoses, as these incidents were too rare to accurately investigate.

“Previously, there has been little information on adverse effects related to opioid use in breast cancer survivors following active cancer treatment, and no studies included an age-matched comparison group,” Dr. Haque pointed out. “Opioid use was common in older women in general, regardless of whether they were breast cancer survivors or in the matched comparison group. However, we saw important differences between these 2 groups.”

Brady-Rogers added, “As a mental health professional, I’m curious about patients’ use of opioids after active cancer treatment. In light of the opioid epidemic and the potential for patient misuse and abuse of prescription medications, I want to know more about how patients are distinguishing between physical and emotional pain. I want to help them develop coping skills to address the psychological impact of breast cancer and wean themselves off of opioids as readily as possible.”

Dr. Haque suggested that these findings underscore the need for careful monitoring of opioid use in these survivors and the exploration of alternative pain management strategies.

“Within Kaiser Permanente’s system that integrates a patient’s medical and pharmacy records, physicians can track the amount of pain medication prescribed and picked up. Potential areas we should explore include using different strategies to manage pain, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), connecting patients with psychosocial support to help them find behavioral methods to manage pain, and anti-depressants, which have recently been identified as a potential alternative.

The study received funding from the California Breast Cancer Research Program.

In addition to Dr. Haque and Moira Brady-Roberts, other authors on the research included: Lie Hong Chen, DrPH; Jiaxiao Shi, PhD; Zheng Gu, MPH; and senior author, Rulin C. Hechter MD, PhD, of the Department of Research & Evaluation in Pasadena, Calif; and Rowan T. Chlebowski, MD, PhD, of The Lundquist Research Institute for Biomedical Innovation at Harbor-UCLA and the Division of Medical Oncology and Hematology, in Torrance, Calif. Dr. Haque is also on the faculty of the Kaiser Permanente Bernard J. Tyson School of Medicine.