Long‐term opioid use in curative‐intent radiotherapy: One‐Year outcomes in head/neck cancer patients

Abstract

Background No study has determined the incidence of long‐term opioid use, or risk factors for long‐term use, ≥1 year after radiotherapy. Methods Medical records of 276 head/neck cancer patients were retrospectively assessed for persistent opioid use 1‐year after curative‐intent radiotherapy. Numerous potential risk factors were assessed and the physicians' documented reasons for continued use were qualitatively categorized as suspected opioid use disorder (OUD) or as medically indicated for control of ongoing pain. Results Of note, 20 of 276 patients continued using opioids long‐term. High maximum opioid dose and the use of opioids and/or psychotropics/non‐opioid analgesics at the radiation oncology intake visit were associated with this outcome. Three patients continued due to suspected OUD and 17 due to medical indications. Conclusion Of note, 7.2% of patients developed long‐term opioid use, which was associated with high maximum opioid dose and early initiation of opioids and/or psychotropics/non‐opioid analgesics. Physicians cited medical indications as the primary reason for continued use.

Trends in chronic opioid therapy among survivors of head and neck cancer

“…In the first 6 years after diagnosis, the rates of COT among opioid‐naïve HNC survivors ranged from 4.5% to 6.1%. These rates are lower than have been seen in single‐institution studies following HNC patients receiving either radiation therapy or undergoing surgery (7%‐15%) 23,24 . Our findings likely reflect the heterogeneous histology in this nationwide registry, because patients with tumors at different sites have differing distributions of age, treatment modalities, and pain burden—all of which, in turn, may be associated with opioid use.…”

“…These rates are lower than have been seen in single-institution studies following HNC patients receiving either radiation therapy or undergoing surgery (7%-15%). 23,24 Our findings likely reflect the heterogeneous histology in this nationwide registry, because patients with tumors at different sites have differing distributions of age, treatment modalities, and pain burden-all of which, in turn, may be associated with opioid use. The lower opioid rates in our study may reflect the restriction of our analysis to opioid-naïve, older survivors.…”

“…17,21,22 Single institution retrospective reviews have found that 7% to 15% of patients treated for HNC continued to use opioids at >1 year out from curative intent radiation therapy or surgery. 23,24 These studies do not elucidate whether HNC survivors actually have higher rates of chronic opioid use than people without cancer. A recent study of survivors of other cancers have shown dramatic differences in chronic opioid use between cancer populations, limiting the ability to generalize across cancers.…”

“…There is limited evidence characterizing the risk of opioid dependence in the years after treatment for HNC 17,21,22 . Single institution retrospective reviews have found that 7% to 15% of patients treated for HNC continued to use opioids at >1 year out from curative intent radiation therapy or surgery 23,24 . These studies do not elucidate whether HNC survivors actually have higher rates of chronic opioid use than people without cancer.…”

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single‐institution retrospective analysis characterizing patients who did not require opioid therapy

“…Although most patients with head and neck cancer receive an opioid prescription during their curative treatment course, less than 15% continue to use opioids after 6 months 10,11 . A previously published analysis of patients with head and neck cancer at our institution found that just 7.2% of patients continued to use opioids 12 months after treatment, nearly all of whom had developed a chronic pain syndrome 12 . In that analysis, maximum opioid dose and psychotropic or non‐opioid use at intake were factors associated with continued opioid use at 12 months.…”