Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post‐head and neck cancer diagnosis: A longitudinal study

Henry, Mélissa; Alias, Ali; Frenkiel, Saul; Richardson, Keith; Hier, Michael P.; Zeitouni, Anthony; Kost, Karen; Mlynarek, Alex; Black, Martin J.; MacDonald, Christina; Chartier, Gabrielle; Rosberger, Zeev

doi:10.1002/pon.4917

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…In the United States, three out of four patients with cancer receive opioids for cancer pain management [1,2]. In patients with head and neck cancers, opioids are frequently prescribed (55.5-83.1%) in the early phases of oncological treatments, and in 39.3% they are given in high dosages [3,4]. This evidence supports previous studies indicating that patients with head and neck cancers have greater odds of receiving opioids during their cancer treatment [5][6][7].…”

Section: Introductionsupporting

confidence: 77%

“…This entity is defined as the use of opioids between 90 to 180 days after surgery and in a large cohort of mixed cancer patients; its rate ranged from 4.5% to 58.9% [12]. The unintended consequences of persistent opioid use include tolerance, misuse, and lower levels of quality of life [4]. Therefore, it has been suggested that the understanding of the patterns of opioid use after surgery should be one of the initial steps to avoid persistent opioid use, misuse, and diversion [13].…”

Section: Introductionmentioning

confidence: 99%

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Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma

et al. 2019

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Background Recently, the concept of persistent postsurgical opioid use has been described for patients undergoing cancer surgery. Our hypothesis was based on the premise that patients with oral tongue cancer require high dosages of opioids before, during, and after surgery, and thus a large percentage of patients might develop persistent postsurgical opioid use. Methods After institutional review board approval, we conducted a retrospective study that included a cohort of patients with oral tongue cancers who underwent curative-intent surgery in our institution. Multivariable logistic regression models were fit to study the association of the characteristics of several patients with persistent (six months after surgery) and chronic (12 months after surgery) postoperative opioid use. Results A total of 362 patients with oral tongue malignancies were included in the study. The rate of persistent use of opioids after surgery was 31%. Multivariate analysis showed that patients taking opioids before surgery and those receiving adjuvant therapy were 2.9 and 1.78 times more likely to use opioids six months after surgery. Fifteen percent of the patients were taking opioids 12 months after surgery. After adjusting for clinically relevant covariates, patients complaining of moderate tongue pain before surgery and those taking opioids preoperatively had at least three times higher risk of still using these analgesics one year after surgery. Conclusions Patients with oral tongue cancers have a high risk of developing persistent and chronic postsurgical opioid use.

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Section: Introductionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma

et al. 2019

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“…Importantly, these efforts should be integrated into primary care and school‐based health clinics because, as survivors become further from treatment, they may not see oncology specialists as frequently. Additional efforts may include integrating behavioral health services and substance abuse specialists into survivor care for AYA patients 28,37 …”

Section: Discussionmentioning

confidence: 99%

Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors—Results from a national survey

Cummings

Mertens

et al. 2021

Cancer

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Background Substance use can exacerbate cancer‐related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors. Methods The authors used data from the National Survey of Drug Use and Health (2015‐2018) to identify a nationally representative sample of AYAs aged 12 to 34 years. Outcomes assessed past‐year tobacco, alcohol, marijuana, and illicit drug use; misuse of prescription opioids; SUDs; and SUD treatment. Multiple logistic regression was estimated to compare outcomes between 832 AYAs who reported a cancer history (survivors) and 140,826 AYAs who did not, adjusting sequentially for sociodemographic characteristics and health status. Results In regressions adjusting for sociodemographic characteristics, survivors were more likely than a noncancer comparison group of peers to use alcohol (6% relative increase; P = .048) and illicit drugs (34% relative increase; P = .012), to misuse prescription opioids (59% relative increase; P < .001), and to have a marijuana (67% relative increase; P = .011), illicit drug (77% relative increase; P < .001), or prescription opioid (67% relative increase; P = .048) SUD. When further adjusting for health status, survivors were still 41% more likely (P < .001) to misuse prescription opioids than noncancer peers. Among those with SUDs, survivors were more likely than peers to receive treatment (unadjusted, 21.5% vs 8.0%; adjusted, P < .05). Conclusions AYA survivors were as likely as or more likely than noncancer peers to report substance use problems. These findings underscore the importance of interventions to reduce substance use and improve SUD treatment among AYA cancer survivors. Lay Summary The authors assessed substance use, misuse, and substance use disorders, as well as the receipt of treatment for substance use disorders, among adolescent and young adult (AYA) cancer survivors. In a nationally representative AYA sample, cancer survivors, despite their increased risk for morbidity and early mortality, were as likely as or more likely than peers without cancer to experience substance use problems. In particular, survivors had a significantly higher rate of prescription opioid misuse than peers. However, only 1 in 5 AYA survivors who experienced substance use disorders received treatment. These findings underscore the importance of interventions toward reducing substance use and improving access to treatment among AYA survivors.

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“…We selected these cancers to represent common cancers (breast, colorectal, and lung), cancers with significant long-term survival (breast, colorectal, and head and neck), cancers with alcohol and tobacco as predominant risk factors (lung, head and neck, and colorectal), cancers that might be treated with multimodality therapy (including hormone therapy for breast and prostate cancers and targeted and immune therapies for lung cancer), and cancers with a high burden of posttreatment pain (lung and head and neck). [35][36][37][38][39][40][41][42][43][44][45][46][47] To minimize the inclusion of LTOT episodes prescribed during cancer treatment or at the end of life, follow-up began 1 year after diagnosis and was censored at hospice entry, a second cancer diagnosis, 6 months before death, or the end of 2016. Survivors were excluded if they did not have continuous coverage through Medicare Parts A, B, and D from 1 year before the diagnosis through the end of follow-up.…”

Section: Data Source and Cohortmentioning

confidence: 99%

Safety of opioid prescribing among older cancer survivors

Salz

Mishra

Gennarelli

et al. 2021

Cancer

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BACKGROUND:Cancer survivors receive more long-term opioid therapy (LTOT) than people without cancer, but the safety of LTOT prescribing is unknown. METHODS: Opioid-naive adults aged ≥66 years who had been diagnosed in 2008-2015 with breast, lung, head and neck, or colorectal cancer were identified with data from Surveillance, Epidemiology, and End Results cancer registries linked with Medicare claims. Survivors with 1 or more LTOT episodes (≥90 consecutive days) occurring ≥1 year after their cancer diagnosis and before censoring at hospice entry, another cancer diagnosis, 6 months before death, or December 2016 were included. The safety of prescribing during the first 90 days of the first LTOT episode was measured during follow-up. As a positive safety indicator, the proportion of survivors with concurrent nonopioid pain management was measured. Indicators of less safe prescribing were the proportion of survivors with a high average daily opioid dose (≥90 morphine milligram equivalents) and the proportion of survivors with concurrent benzodiazepine dispensing. Multivariable logistic regression analyses were conducted to identify clinical predictors of each safety outcome. RESULTS: In all, 3628 cancer survivors received LTOT during follow-up (median duration, 4.9 months; interquartile range, 3.5-8.0 months). Seventy-two percent of the survivors received multimodal pain management concurrently with LTOT. Eight percent of the survivors had high-dose opioid prescriptions; 25% of the survivors received benzodiazepines during LTOT. Multivariable analyses identified variations in safety measures by multiple clinical factors, although none were consistently significant across outcomes. CONCLUSIONS: To improve safe LTOT prescribing for survivors, efforts should focus on increasing multimodal pain management and reducing inappropriate benzodiazepine prescribing. Different clinical predictors of each outcome suggest different drivers of safe prescribing.

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Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post‐head and neck cancer diagnosis: A longitudinal study

Cited by 14 publications

References 40 publications

Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma

Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma

Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors—Results from a national survey

Safety of opioid prescribing among older cancer survivors

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