Risk of Chronic Opioid Use After Radiation for Head and Neck Cancer: A Systematic Review and Meta-Analysis

Zayed, Sondos; Lin, Cindy; Boldt, Gabriel; Sathya, Jinka; Venkatesan, Varagur; Read, Nancy; Mendez, Lucas C.; Moulin, Dwight E.; Palma, David A.

doi:10.1016/j.adro.2020.09.023

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…The percentage of patients who continue to require daily opioids ranges widely from 15% to 55% at 6 months posttreatment. 22 23…”

Section: Opioid Misusementioning

confidence: 99%

“…24 25 26 27 These may be useful in screening patients after 6 months when the acute posttreatment pain and inflammation have resolved. 22 28 Furthermore, encouraging patients to complete a pain diary can be useful in identifying not only the degree of pain experienced by the patient, but also even alternative approaches utilized by patients to help alleviate their pain. 29…”

Section: Opioid Misusementioning

confidence: 99%

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Psychological Survivorship in Head and Neck Cancer

2022

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Survivorship for head and neck cancer patients presents unique challenges related to the anatomic location of their disease. After treatment, patients often have functional impairments requiring additional care and support. In addition, patients may have psychological challenges managing the effect of the disease and treatment. Routine screening is recommended for the identification of psychological conditions. This article reviews the latest research on key psychological conditions associated with head and neck cancer. It discusses risk factors for the development of each condition and provides recommendations for the management of patients who may present with psychological concerns.

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“…The percentage of patients who continue to require daily opioids ranges widely from 15% to 55% at 6 months posttreatment. 22 23…”

Section: Opioid Misusementioning

confidence: 99%

Section: Opioid Misusementioning

confidence: 99%

Psychological Survivorship in Head and Neck Cancer

2022

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“…Currently, opioid therapy remains the cornerstone of HNC pain management [3,[10][11][12][13][14]. In fact, patients with HNC have a higher prevalence of pain compared to other cancer types and this often translates into significantly higher rates of opioid prescription and substantially increases their risk for chronic opioid use [13,15,16]. Although effective for pain relief, opioids confer noteworthy morbidity in the form of nausea, vomiting, constipation, sedation, respiratory depression, hallucinations, tolerance, and dependence [10,13].…”

Section: Introductionmentioning

confidence: 99%

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

et al. 2021

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Background Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients. Methods In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain. Discussion This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT. Trial registration ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

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“…12 Opioids have long been a mainstay of HNC pain management, 13,15 but their utilization may come at a cost, such as dependence, overdose, and excessive health care system expenditure. 15,16 Compared with the general population, patients with HNC have higher prevalence of long-term opioid use 17,18 and may require higher levels of pain management. 12,19 Given that a majority of patients with HNC are likely to use some form of pain management as part of care and report inadequate pain management (over 80% of patients with HNC), [20][21][22] there is a need for a better understanding of patient-reported pain.…”

mentioning

confidence: 99%

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

Canick

Bhardwaj²,

Patel³

et al. 2023

JCO Oncology Practice

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PURPOSE: While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. METHODS: We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. RESULTS: Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). CONCLUSION: We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.

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Risk of Chronic Opioid Use After Radiation for Head and Neck Cancer: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 18 publications

Psychological Survivorship in Head and Neck Cancer

Psychological Survivorship in Head and Neck Cancer

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

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