Lucian Zhao1, Dominic H Moon1, Vladimir Avkshtol1, Caitlin H Siropaides2, Stephanie Terauchi2, Andrew T Day3, Baran D Sumer3, Randall Hughes4, David J Sher5. 1. Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Drive, Dallas, TX, 75390, USA. 2. Section of Supportive and Palliative Care, Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA. 3. Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX, USA. 4. Department of Medical Oncology, UT Southwestern Medical Center, Dallas, TX, USA. 5. Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Drive, Dallas, TX, 75390, USA. david.sher@utsouthwestern.edu.
Abstract
PURPOSE: Acute and chronic pain during and after radiotherapy is an important driver of poor quality of life. We aimed to identify risk factors associated with increased chronic opioid use in head and neck squamous cell cancer survivors. METHODS: We performed a retrospective cohort analysis on head and neck squamous cell cancer patients treated with definitive or adjuvant intensity-modulated radiotherapy. We tracked their oncologic opioid prescription profile from initial presentation to the last follow-up date. We determined the incidences of 1- and 2-year opioid use and performed multivariate logistic regression for both outcomes. RESULTS: Our analytic cohort consisted of 403 head and neck squamous cell cancer survivors. The numbers of patients requiring opioids at 3 months, 6 months, and 1 year after treatment were 316 (78%), 203 (50%), and 102 (25%), respectively. On multivariate logistic regression, positive smoking history (95% CI 1.86 [1.03, 3.43], p = 0.04), unemployment (95% CI 2.33 [1.16, 4.67], p = 0.02), prior psychiatric illness (95% CI 2.15 [1.05, 4.40], p = 0.03), and opiate use before radiotherapy (95% CI 2.75 [1.49, 5.20], p = 0.01) were independently associated with significantly greater odds of opioid use at 1 year. CONCLUSIONS: Our institutional analysis has shown that a substantial amount of head and neck cancer survivors are chronically dependent on opioids following radiotherapy. We have identified a cohort at highest risk for long-term use, for whom early interventions should be targeted.
PURPOSE: Acute and chronic pain during and after radiotherapy is an important driver of poor quality of life. We aimed to identify risk factors associated with increased chronic opioid use in head and neck squamous cell cancer survivors. METHODS: We performed a retrospective cohort analysis on head and neck squamous cell cancer patients treated with definitive or adjuvant intensity-modulated radiotherapy. We tracked their oncologic opioid prescription profile from initial presentation to the last follow-up date. We determined the incidences of 1- and 2-year opioid use and performed multivariate logistic regression for both outcomes. RESULTS: Our analytic cohort consisted of 403 head and neck squamous cell cancer survivors. The numbers of patients requiring opioids at 3 months, 6 months, and 1 year after treatment were 316 (78%), 203 (50%), and 102 (25%), respectively. On multivariate logistic regression, positive smoking history (95% CI 1.86 [1.03, 3.43], p = 0.04), unemployment (95% CI 2.33 [1.16, 4.67], p = 0.02), prior psychiatric illness (95% CI 2.15 [1.05, 4.40], p = 0.03), and opiate use before radiotherapy (95% CI 2.75 [1.49, 5.20], p = 0.01) were independently associated with significantly greater odds of opioid use at 1 year. CONCLUSIONS: Our institutional analysis has shown that a substantial amount of head and neck cancer survivors are chronically dependent on opioids following radiotherapy. We have identified a cohort at highest risk for long-term use, for whom early interventions should be targeted.
Authors: Andrew G Shuman; Jeffrey E Terrell; Emily Light; Gregory T Wolf; Carol R Bradford; Douglas Chepeha; Yunyun Jiang; Scott McLean; Tamer A Ghanem; Sonia A Duffy Journal: Arch Otolaryngol Head Neck Surg Date: 2012-12-01
Authors: Lucas K Vitzthum; Paul Riviere; Paige Sheridan; Vinit Nalawade; Rishi Deka; Timothy Furnish; Loren K Mell; Brent Rose; Mark Wallace; James D Murphy Journal: J Natl Cancer Inst Date: 2020-07-01 Impact factor: 13.506