New and Persistent Sedative-Hypnotic Use after Adjuvant Chemotherapy for Breast Cancer

Abstract Background Sedative-hypnotic medications are used to treat chemotherapy-related nausea, anxiety and insomnia. However, prolonged sedative-hypnotic use can lead to dependence, misuse and increased healthcare utilization. We aimed to estimate the rates at which patients who receive adjuvant chemotherapy for breast cancer become new persistent users of sedative-hypnotic medications, specifically benzodiazepines and non-benzodiazepine sedative-hypnotics (Z-drugs). Methods Using the MarketScan health care claims database, we identified sedative-hypnotic -naïve patients who received adjuvant chemotherapy for breast cancer. Patients who filled ≥ 1 prescriptions during chemotherapy and ≥ 2 prescriptions up to one year after chemotherapy were classified new persistent users. Univariate and multivariable logistic regression analyses were used to estimate odds of new persistent use and associated characteristics. Results We identified 22,039 benzodiazepine-naïve patients and 23,816 Z-drug-naïve patients who received adjuvant chemotherapy from 2008–2017. Among benzodiazepine-naïve patients, 6,159 (27.9%) filled ≥ 1 benzodiazepine prescriptions during chemotherapy, and 963 of those (15.6%) went on to become new persistent users. Among Z-drug-naïve patients, 1,769 (7.4%) filled ≥ 1 prescriptions during chemotherapy, and 483 (27.3%) became new persistent users. In both groups, shorter durations of chemotherapy and receipt of opioid prescriptions were associated with new persistent use. Medicaid insurance was associated with new persistent benzodiazepine use (OR 1.88 [95% CI 1.43–2.47]) compared to commercial/Medicare insurance. Conclusion Patients who receive sedative-hypnotic medications during adjuvant chemotherapy for breast cancer are at risk of becoming new persistent users of these medications after chemotherapy. Providers should ensure appropriate sedative-hypnotic use through tapering dosages and encouraging non-pharmacologic strategies when appropriate.