Researchers found that patients with pancreatic cancer receiving chemotherapy saw worse survival outcomes when taking Ativan, commonly prescribed to treat anxiety. What other mental health options are available?
Taking Ativan (lorazepam), a medication commonly prescribed to treat anxiety, resulted in worse survival outcomes for patients with pancreatic cancer who were receiving chemotherapy, according to the findings of a recent study.
Researchers found that patients who took Ativan were 3.83 times more likely to experience disease progression or death when compared to patients who did not, according to a news release from the American Association of Cancer Research. However, patients treated with Xanax (alprazolam) experienced 62% lower risk of disease progression or death than those who did not, according to the release.
Researchers studied the investigation between use of benzodiazepines, a category of drugs which suppress the activity in the central nervous system, and survival outcomes among patients at the Roswell Park Comprehensive Cancer Center in Buffalo, New York.
It was found that among patients with prostate, pancreatic, ovarian, kidney, head and neck, endometrial, colon, breast or brain cancer, or melanoma, 30.9% received benzodiazepines, with patients with pancreatic cancer having the highest usage rate, 40.6%, according to study results published Aug. 17 in the American Association for Cancer Research journal Clinical Cancer Research.
“When we study response to therapy, we think of treatments like chemotherapy or immunotherapy, but patients are also given a lot of medicines for anxiety and pain,” Michael Feigin, associate professor of pharmacology and therapeutics at Roswell Park Comprehensive Cancer Center and senior author of the study, said in the news release. “We wanted to understand the impact of some of these palliative care drugs on the tumor.”
Benzodiazepine use was associated with a 30% lower risk of pancreatic cancer-related death when adjusted for factors including age, race, sex, disease stage and progression and treatments received, but Ativan was associated with worse survival among patients with prostate, ovarian, head and neck, uterine, colon, and breast cancers, as well as melanoma, according to the news release.
Nicole Lise Feingold, senior director of patient services for the Pancreatic Cancer Action Network (PanCAN), spoke with CURE® via email about these study findings, the role of mental health in a pancreatic cancer journey and more.
Q: What do you think should be the big takeaway from this study for patients with pancreatic cancer?
A: The research team at Roswell Park explored clinical data for patients with pancreatic cancer who also took lorazepam (Ativan), alprazolam (Xanax) or other antianxiety medications. They found a trend that suggests people who take (Ativan) may experience a shorter progression-free survival (duration of time before their disease returns or worsens) compared to patients who take other types of antianxiety medications or no medicine for anxiety.
The investigators also looked for potential biological explanations for this observation, and they found that exposure to (Ativan) may lead to more inflammation (swelling) around the tumor, which can stimulate tumor growth. Additional research will be necessary to understand the clinical and biological effects of antianxiety medications in combination with chemotherapy for people with pancreatic cancer.
People with pancreatic cancer should use this study as a reminder of how important it is to take an active role in their care. Therefore, don’t be afraid to ask questions, seek second opinions, and always advocate for yourself. Specifically, if you have questions about how this study impacts your care, discuss it with your health care team.
Q: Given the findings of this study regarding the effects of Ativan on patients with pancreatic cancer undergoing chemotherapy treatment, what are some things patients should keep in mind in general regarding potential treatment interactions and side effects?
A: It is very encouraging to see researchers studying the effects of different types of cancer-fighting and supportive care medications. Understanding how drugs work and potentially interact with other medications is important to know in order to provide the best care for each patient. An important role for the patient is to inform their medical team of any new or changing symptoms or side effects they may be experiencing.
Q: What sorts of conversations should patients be having with the different doctors on their care team before beginning different lines of treatment – in this case, chemotherapy and anti-anxiety medication?
A: It’s important to keep track of any new or worsening symptoms or side effects a patient may experience between appointments and let their healthcare team know. Their healthcare team can then provide options to help manage symptoms and side effects and discuss risk and benefits of any new medications that may be introduced. If a patient and their family are concerned about the results of this study, they can bring it up with their medical team to determine whether to start or stop any medications.
Pancreatic cancer is a serious illness that can cause anxiety and depression in some people. Everyone facing this disease should remember that mental health is just as important as physical health — anxiety and depression should be addressed just like you would a cough, headache, nausea or any other side effect.
Q: How commonly prescribed are Ativan and other anti-anxiety medications among patients with pancreatic cancer?
A: It is hard to say exactly how often these medications are prescribed for pancreatic cancer patients, since they are used routinely. Anxiety and depression are common with pancreatic cancer. This may be due to the biology of the disease, or because cancer can be so life-changing. Again, it is important to communicate with the healthcare team about mental health.
Q: What alternative treatments, both pharmaceutical options and otherwise, are available to help patients manage anxiety during their cancer experience?
A: There are many options available to pancreatic cancer patients to address anxiety. Medications like (Ativan) can be used alongside non-pharmacological interventions, like talk therapy, massage, meditation, etc.
Supportive care, sometimes called palliative care, is a discipline of medicine that aims to relieve suffering for people with chronic or long-term illnesses. Supportive care should be considered at every step of treatment. PanCAN Patient Services Case Managers can help patients and loved ones find resources to help address anxiety.
Q: Is there anything else you would like patients to know regarding this topic?
A: Scientific and clinical researchers are working tirelessly to study everything from the biology of a single pancreatic cancer cell to the lived experiences of people with the disease. PanCAN supports and conducts research aiming to improve early detection strategies, develop better treatment options, and improve outcomes for everyone affected by pancreatic cancer.
In addition, the PanCAN Patient Services Help Line is here for patients, families and healthcare professionals, providing resources and information about managing their risk, diagnostic tools, treatment options, clinical trials, supportive care and more. For free, 1:1 support from one of PanCAN’s qualified Case Managers, contact 1-877-2-PANCAN (1-877-272-6226).