Giving Compass’ Take:
• Rajesh Balkrishnan discusses his experience as an epidemiologist in rural Appalachia where he sees patients survive breast cancer only to die because of opioids.
• How can funders help to increase healthy paths for breast cancer survivors? What unique factors influence the lives of rural cancer patients?
• Learn about rural opioid prevention and treatment strategies.
The availability of life-prolonging treatments such as hormonal therapies and other targeted chemotherapy has led to a sharp decline in breast cancer deaths in the United States.
But despite these advances, there’s a troubling discrepancy in America. Breast cancer death rates continue to remain abnormally high in the Appalachian region of the United States, and it’s partially due to a different epidemic in the U.S: opioid use.
I am an epidemiologist who specializes in cancer, and I began investigating this issue five years ago to try to come up with a picture of what was happening. One thing that struck me when I looked at health insurance and cancer registry data was the extremely high and prolonged rate of use of dangerous medications like opioids in this population, sometimes as high as 50 percent in some areas.
Life-saving hormone treatments are often associated with side effects such as pain and muscle weakness. Although opioids are not considered first-line treatment for cancer-related pain, they are increasingly used to manage unbearable pain in breast cancer survivors. And that, my research shows, could be influencing breast cancer death rates to the tune of 60 percent in rural Appalachia.
We find many patients in Appalachia who undergo successful breast cancer treatment and then start life-prolonging hormone treatments along with opioids to manage side effects such as pain. But many (over half in some counties) continue to remain on opioids, which are usually supposed to be prescribed only for the short term, and then discontinue long-term survivorship treatments such as hormones. The reasons these women discontinue traditional treatments is not completely clear, but my colleagues and I suspect it is related to people’s dependence on opioids.
The addictive nature of the opioids, the overall feelings of hopelessness and other regional issues such as poverty and drug diversion make this a complex and complicated treatment issue and one that needs more awareness and education of both survivors and their medical providers.
Read the full article about breast cancer survival in rural Appalachia by Rajesh Balkrishnan at The Conversation.
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