Why It’s Important to Taper Patients After Chemo from Prescribed Benzos
Chemotherapy patients face a host of competing challenges, from the impacts of cancer itself to the treatment’s side effects. Although many may think of chemotherapy and radiation as the main side effects of cancer treatment, the truth is those effects are typically time-limited and resolve when treatments are discontinued. There’s an often overlooked treatment, however, with debilitating side effects that can last for months or years after discontinuation — benzodiazepines.
In the scheme of overall care, prescribing benzodiazepines to cancer patients for symptoms like anxiety and insomnia can seem like a relatively low-stakes intervention. But considering the potential long-term impacts of benzo use is essential to ensuring quality of life for cancer survivors.
While benzos may effectively address side effects of chemotherapy, the development of medication dependency should be of utmost concern to patients and providers.
“It can be really harmful for cancer patients to become dependent on these medications unnecessarily,” says Lucid Lane co-founder Dr. Amer Raheemullah. “If their cancer is in remission but they’re struggling with benzodiazepine dependence , then it becomes very difficult for them to have a good quality of life.”
Raheemullah says it’s important to thoroughly explore alternatives to benzos that may address patient needs, if the drugs can be avoided altogether. Because they can cause many significant side effects, benzos are only meant for short-term use. If and when benzos are prescribed, providers and patients should be careful to adhere to limited treatments designed to address acute symptoms, rather than ongoing use that can beget tolerance and dependency.
Regardless of how a patient has used benzos, slow and carefully supported tapering from the medication is key to managing dependency and ensuring good quality of life.
Why prescribe benzodiazepines to chemo patients?
Benzodiazepines are a psychoactive drug class designed to treat a range of symptoms, including anxiety, insomnia, panic attacks, nausea, and more. While they can be used to address anxiety or side effects of chemotherapy, it’s important for providers to weigh the dangers as well as the benefits. Many patients may start these medications for chemotherapy-induced nausea, and, inadvertently, continue them to help cope with the stress and anxiety of a cancer diagnosis. Benzodiazepines, however, should not be first-line for dealing with stress, anxiety, or insomnia.
“We shouldn’t prescribe benzodiazepines without thinking about the pros and cons for the patient,” Raheemullah says. “If they improve in terms of their cancer diagnosis, dependence on benzodiazepines can cause additional problems in their life afterward.”
There are highly effective medications, targeting nausea and insomnia, for example, that ought to be considered as a first line of treatment before prescribing benzos. Should a patient not respond to other medications, and benzo use is indicated, it should be limited to their needs during a particular cancer treatment cycle. That may include having benzo-free days built in when they are symptom free, Raheemullah says.
What are the dangers of overusing benzos?
Sustained benzo use leads to tolerance and dependency, which can actually worsen the symptoms the medication is designed to treat.
Raheemullah describes a kind of quicksand effect: Tolerance to benzodiazepines can lead to breakthrough anxiety, as patients experience lessened effects of the medication. And the cardinal feature of withdrawal from benzos is anxiety, which can result in a fresh source of anxiety. In the case that a patient’s cancer improves such that it’s no longer a source of underlying worry, they may be stuck with anxiety from benzo withdrawal in the longer term.
With cancer outcomes improving at a celebrated rate, the potential challenges that survivors may face from side effects to secondary medications has become an increasingly urgent concern.
How can benzo dependency be safely addressed?
Slow and supported tapering off benzodiazepines is paramount for successfully managing dependency and concluding a course of treatment.
“Lucid Lane provides evidence-based treatment to help people taper off of benzodiazepines while dealing with anxiety that comes up during the process,” Raheemullah says. It’s important for providers to distinguish between underlying anxiety, which may derive from the stress of managing a chronic illness, in the case of chemo patients, from anxiety that arises as a result of benzo withdrawal.
“Oftentimes, when a patient who is dependent on benzodiazepines develops some anxiety symptoms after a reduction in medication, physicians will misinterpret that to be a worsening of their underlying anxiety and a need to continue benzodiazepines,” Raheemullah says. “In reality, that’s part of the project of tapering.”
Tapering slowly and in a way that centers patient needs is key to Lucid Lane’s strategy. Talk therapy to manage underlying symptoms that are likely to arise as medication gets phased out is another essential component of the process.
“A slow taper in combination with cognitive behavioral therapy for patients’ underlying symptoms have been shown to increase the comfort and success of tapers in multiple studies,” Raheemullah says.
The use of benzodiazepines for addressing symptoms in chemotherapy patients should be considered carefully and with caution. For patients managing dependency, slow and supported tapering of treatment offers optimal likelihood for success. Survivors of chronic illness deserve the best quality of life possible, free from dependency and withdrawal caused by medications designed to help them.
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