William H Smith1, Ian Luskin2, Lucas Resende Salgado1, Bethann M Scarborough3, Jung-Yi Lin4, Umut Özbek4, Brett A Miles5, Vishal Gupta1, Richard L Bakst6. 1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA. 2. Riverdale Country School, Riverdale, Bronx, NY, USA. 3. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1070, New York, NY 10029, USA. 4. Biostatistics Shared Resource Facility, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1077, New York, NY, USA. 5. Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1189, New York, NY, USA. 6. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA. Electronic address: richard.bakst@mountsinai.org.
Abstract
OBJECTIVE: Patients undergoing radiation treatment (RT) for head and neck malignancies often suffer significant disease- and treatment-related pain requiring opioids for effective management. However, the prevalence and associated risk factors of prolonged opioid use in this population remain poorly characterized. We sought to quantify the rate of prolonged opioid use among opioid naïve patients receiving curative-intent RT for head and neck malignancies and to identify associated risk factors. METHODS: We retrospectively identified patients who had undergone RT for head and neck malignancies at our institution between Jan 2011 and Sept 2017. Our primary endpoint was persistent opioid use 6-months following completion of RT. Patients were included if they were opioid-naïve, underwent curative intent RT, had adequate follow-up, and did not have residual or recurrent disease within our follow-up period. Univariable and multivariable logistic regression was utilized to identify risk factors for prolonged opioid use. RESULTS: We identified 311 patients meeting our inclusion criteria; 40 (12.9%) continued to use opioids 6-months following RT. Univariable analysis found current smoking, alcohol abuse, RT dose, treatment to the bilateral necks, induction chemotherapy, concurrent chemotherapy, PEG tube, daily milligram morphine equivalents, and adjuvant analgesic medication use to be positively associated with prolonged opioid use; prior surgery was negatively associated with prolonged opioid use. Delivery of induction chemotherapy (OR 2.86, CI (95%) 1.32-6.21) and alcohol abuse (OR 3.75, CI (95%) 1.66-8.47) remained statistically significant on multivariable analysis. CONCLUSION: The prevalence of prolonged opioid use in previously opioid naïve patients undergoing curative intent head and neck RT was just under 13%. Patients with history of alcohol abuse and those who undergo induction chemotherapy were most at risk.
OBJECTIVE:Patients undergoing radiation treatment (RT) for head and neck malignancies often suffer significant disease- and treatment-related pain requiring opioids for effective management. However, the prevalence and associated risk factors of prolonged opioid use in this population remain poorly characterized. We sought to quantify the rate of prolonged opioid use among opioid naïve patients receiving curative-intent RT for head and neck malignancies and to identify associated risk factors. METHODS: We retrospectively identified patients who had undergone RT for head and neck malignancies at our institution between Jan 2011 and Sept 2017. Our primary endpoint was persistent opioid use 6-months following completion of RT. Patients were included if they were opioid-naïve, underwent curative intent RT, had adequate follow-up, and did not have residual or recurrent disease within our follow-up period. Univariable and multivariable logistic regression was utilized to identify risk factors for prolonged opioid use. RESULTS: We identified 311 patients meeting our inclusion criteria; 40 (12.9%) continued to use opioids 6-months following RT. Univariable analysis found current smoking, alcohol abuse, RT dose, treatment to the bilateral necks, induction chemotherapy, concurrent chemotherapy, PEG tube, daily milligram morphine equivalents, and adjuvant analgesic medication use to be positively associated with prolonged opioid use; prior surgery was negatively associated with prolonged opioid use. Delivery of induction chemotherapy (OR 2.86, CI (95%) 1.32-6.21) and alcohol abuse (OR 3.75, CI (95%) 1.66-8.47) remained statistically significant on multivariable analysis. CONCLUSION: The prevalence of prolonged opioid use in previously opioid naïve patients undergoing curative intent head and neck RT was just under 13%. Patients with history of alcohol abuse and those who undergo induction chemotherapy were most at risk.
Authors: Laura W J Baijens; Margaret Walshe; Leena-Maija Aaltonen; Christoph Arens; Reinie Cordier; Patrick Cras; Lise Crevier-Buchman; Chris Curtis; Wojciech Golusinski; Roganie Govender; Jesper Grau Eriksen; Kevin Hansen; Kate Heathcote; Markus M Hess; Sefik Hosal; Jens Peter Klussmann; C René Leemans; Denise MacCarthy; Beatrice Manduchi; Jean-Paul Marie; Reza Nouraei; Claire Parkes; Christina Pflug; Walmari Pilz; Julie Regan; Nathalie Rommel; Antonio Schindler; Annemie M W J Schols; Renee Speyer; Giovanni Succo; Irene Wessel; Anna C H Willemsen; Taner Yilmaz; Pere Clavé Journal: Eur Arch Otorhinolaryngol Date: 2020-12-19 Impact factor: 2.503
Authors: Huaising C Ko; Mandira N Mehra; Adam R Burr; Aaron M Wieland; Randal J Kimple; Gregory K Hartig; Paul M Harari; Matthew E Witek Journal: J Pain Manag Date: 2020
Authors: Leif-Erik D Schumacher; Zoukaa B Sargi; Melissa Masforroll; Deukwoo Kwon; Wei Zhao; Maria A Rueda-Lara; Laura M Freedman; Nagy Elsayyad; Stuart E Samuels; Matthew C Abramowitz; Michael A Samuels Journal: Head Neck Date: 2019-11-30 Impact factor: 3.147
Authors: Sondos Zayed; Cindy Lin; R Gabriel Boldt; Jinka Sathya; Varagur Venkatesan; Nancy Read; Lucas C Mendez; Dwight E Moulin; David A Palma Journal: Adv Radiat Oncol Date: 2020-10-26
Authors: Neerav Goyal; Andrew Day; Joel Epstein; Joseph Goodman; Evan Graboyes; Scharukh Jalisi; Ana P Kiess; Jamie A Ku; Matthew C Miller; Aru Panwar; Vijay A Patel; Assuntina Sacco; Vlad Sandulache; Amy M Williams; Daniel Deschler; D Gregory Farwell; Cherie-Ann Nathan; Carole Fakhry; Nishant Agrawal Journal: Laryngoscope Investig Otolaryngol Date: 2021-11-30