Depression, anxiety linked to reduced survival in breast cancer patients

Elderly women battling breast cancer who have anxiety, depression, or other mental health conditions are more likely to use opioids and are more likely to die, according to a new study by researchers at the University of Virginia School of Medicine in Charlottesville and published in the Journal of Oncology Practice.

Researchers reviewed more than 10,000 breast cancer cases recorded in the national SEER cancer database, which contains detailed but depersonalized information on care provided to Medicare beneficiaries with cancer. These cases consisted of women aged 65 years and older who were diagnosed with stage I, II, or III breast cancer between Jan. 1, 2006, and Dec. 31, 2012. All received adjuvant endocrine therapy as treatment.

The team sorted the cases into two groups: women with mental health diagnoses and those without. They found that those with mental health diagnoses had higher opioid use and lower survival rates.

The researchers noted potential limitations to their study such as a lack of information on the opioids used and a lack of details on the patients' pain assessments. They also suggest that mental health conditions such as depression may be under diagnosed and that, as a result, the research may underestimate the percentage of patients with those conditions.

The findings should encourage doctors to better manage mental health in patients with breast cancer and spur care providers to consider alternative pain management such as physical therapy, massage, and acupuncture, the researchers said.

The complex relationship among breast cancer, mental health problems, and the use of opioids is not well understood and the results of this study provide clinicians the evidence they need to make optimal patient treatment related decisions, said lead researcher Rajesh Balkrishnan, PhD, of the Department of Public Health Sciences and the UVA Cancer Center. "

Our findings suggest that patients with breast cancer with mental health conditions have higher opioid use and reduced survival,” said Balkrishnan in a statement. “These results highlight the need for healthcare providers to evaluate treatment goals and assess whether better concurrent management of breast cancer and mental health conditions is required."