Background: Opioids are frequently used to treat cancer-related pain, yet overuse of prescription painkillers has become a public health epidemic. Chronic opioid use has not been well described after head and neck cancer (HNC) surgery. This study characterizes chronic opioid use and associated clinical factors in patients undergoing surgery for oral cavity cancer.
Methods: Data on patient demographics, medical history, cancer stage, treatment, prescribed post-hospitalization opioids, and chronic opioid use (> 90 days post-operatively) were obtained through retrospective chart review of patients undergoing surgery for oral cavity cancer from 2011 to 2016 at a single academic center. Univariate and multivariate logistic regression was performed to investigate factors associated with chronic opioid use. A multivariable Cox proportional hazards model was used to estimate overall survival.
Results: Ninety-nine patients were included for analysis. Chronic opioid use was observed in 41.4% of patients post-operatively, and 82.4% of these patients were taking opioids specifically for HNC pain. Nearly half (48.7%) were actively receiving their prescription from a HNC treatment provider. Twenty-three percent of patients who were not opioid users before surgery became chronic opioid users after surgery. On multivariate logistic regression, patients with pre-operative opioid use (OR 5.35, CI 1.30 – 21.97, p = 0.020) and prior tobacco use (8.55, CI 1.69 – 43.35, p = 0.010) were more likely to be chronic post-operative opioid users. By contrast, patients with disease-free status without recurrence were less likely to be chronic post-operative opioid users (OR 0.23, CI 0.07 – 0.77, p = 0.018). Multivariable Cox proportional hazards regression showed significantly increased hazard of death in pre-operative opioid users (HR 2.52, CI 1.12 – 5.68, p = 0.025) after adjusting for age, comorbidities, and stage.
Conclusion: In this cohort of patients undergoing surgery for oral cavity tumors, chronic post-operative opioid use was prevalent. Patients with prior tobacco use and pre-operative opioid use were more likely to be chronic post-operative users, whereas patients who had no recurrence after surgery were less likely. Prior opioid use may be a prognostic factor for decreased survival. Further research is indicated to better characterize the implications of chronic opioid use after HNC surgery.