Chronic opioid use after laryngeal cancer treatment

Abstract

Background: Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors. Methods: Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment. Results: In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use. Conclusions: Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.

Prevalence and correlates of high‐dose opioid use among survivors of head and neck cancer

“…Several factors that we found to be associated with being prescribed moderate and high dose opioid therapy at 24-months post treatment were consistent with other literature. We found that those with pre-cancer substance use disorders or opioid prescriptions have an increased risk with lasting moderate dose opioid use, which is consistent with recent literature 38,39 in which being prescribed opioids before cancer, having a history of opioid use disorder, 7,21 a history of tobacco use, 7,21,24,40 or a history of alcohol use 7 were each associated with chronic opioid use 12-months post-diagnosis. 7,21,24,40 Taken together, patients with premorbid mental health and SUD characteristics may benefit from focused pain screening and alternative pain management efforts before, during and directly following cancer treatment.…”

“…We found that those with pre-cancer substance use disorders or opioid prescriptions have an increased risk with lasting moderate dose opioid use, which is consistent with recent literature 38,39 in which being prescribed opioids before cancer, having a history of opioid use disorder, 7,21 a history of tobacco use, 7,21,24,40 or a history of alcohol use 7 were each associated with chronic opioid use 12-months post-diagnosis. 7,21,24,40 Taken together, patients with premorbid mental health and SUD characteristics may benefit from focused pain screening and alternative pain management efforts before, during and directly following cancer treatment. In non-cancer pain management, there is a growing body of literature suggesting that brief pain management interventions prior to surgery decreases postoperative pain and may decrease need for opioid prescriptions.…”

“…19 Survivors of HNC may be at higher risk compared to survivors of other cancer types for negative opioid related outcomes 20 such as long-term opioid use, development of opioid use disorder, and admission for opioid toxicity. 8,21,22 Clinical factors such as pretreatment opioid use, primary chemoradiation, current tobacco use and the presence of a psychiatric disorder have all been associated with the continued use of prescription opioid therapy up to 1 year following the end of treatment. 23,24 A recent prospective study also identified that preexisting anxiety conditions among those with HNC are related to higher cumulative opioid dose 1 year after treatment.…”

Study protocol: randomised controlled trial of conditioned open-label placebo (COLP) for perioperative pain management in patients with head and neck cancer

“…Surgery for head and neck cancer can also significantly impair a patient’s ability to perform daily activities, such as speaking and eating, with potential psychosocial consequences; in fact, up to 50%6 of these patients also suffer from depression and anxiety 4 5. Together, these factors inherently increase the risk of opioid dependence in this patient population, which may be as high as 20%–60% of patients after surgery for head and neck cancer 31 36–38. Additionally, both depression and chronic opioid use in cancer patients have been associated with poorer disease-free and overall survival 31–33…”