Short‐ and Long‐term Opioid Use in Patients with Oral and Oropharynx Cancer

Abstract

Objective. Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment. Study Design. Retrospective population-based study. Setting. Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2008 to 2011. Subjects and Methods. In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors. Results. Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11–5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18–0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05–4.71 and OR, 3.84; 95% CI, 1.44–10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45–5.91 and OR, 3.56; 95% CI, 1.95–6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17–0.62 and OR, 0.26; 95% CI, 0.10–0.67). Conclusion. Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.

Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

“…10,26,[42][43][44] Other factors associated with opioid risk identified in this study such as race, median income, non-abusive alcohol use, comorbidity, BMI and cancer type have not been previously reported. 42,45,46 We found no association between gender and persistent opioid use, which differs from other studies, 10,26,28,43 though one must consider the skewed gender distribution of our study population within the VA healthcare system. Many patient, cancer and treatment related factors were consistently predictive of the three opioid-related study endpoints which likely stems from persistent opioid use being a mediator for downstream adverse opioids events.…”

“…29 Despite these limitations, this current study represents one of the largest comprehensive evaluations of persistent opioid use and abuse in cancer survivors, and the first to construct a predictive model in oncology patients. 24,35,43 The absolute rate of persistent opioid use, abuse and dependence was relatively low among this cohort of cancer survivors, especially among those without prior opioid use. Improved risk stratification will allow for personalized risk assessment and improve the safety of pain management in cancer survivors.…”

Age Is Associated With Pain Experience and Opioid Use After Head and Neck Free Flap Reconstruction

“…Age was among the most significant factors influencing patients’ postoperative pain experience and risk of continued opioid use in this study. The association of younger age with higher prevalence of chronic opioid use has also been reported among oropharynx and oral cavity cancer patients treated with any modality, including surgery . The impact of age on pain and opioid use has not previously been well described among patients undergoing major head and neck reconstructive surgery but is highly relevant to clinical practice for several reasons.…”

“…Although postoperative opioid prescribing is becoming more restricted in an effort to reduce opioid misuse and overdose‐related deaths nationally, the challenge facing surgeons is to minimize reliance on opioids while still adequately and compassionately managing patients’ acute pain . The high rates of long‐term opioid use among head and neck cancer patients underscore the vulnerability of this population to opioid dependence and the importance of thoughtful pain management by the head and neck surgical team. Indeed, several recent studies have reported successful opioid prescription reduction without compromising pain control by implementing multimodal analgesia regimens for head and neck surgery patients …”

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

“…Four studies have reported short‐term rates of continued opioid use 6 months following curative‐intent radiotherapy (7%‐38%) . Unfortunately, there are no studies in the literature with longer follow‐up and the previous studies did not examine the reasons for continued opioid use.…”