Importance: Opioid dependence has become an epidemic in the United States with significant societal costs. While the quality of life and functional benefits of transoral resection of oropharyngeal malignancies have been well-described; the effect of treatment modality on long-term opioid dependence in patients with oropharyngeal cancer has not been previously evaluated.
Objective: To determine the impact of treatment modality on the prevalence of chronic opioid use in patients with T1 and T2 oropharyngeal cancer as well as other risk factors in this population for chronic opioid use.
Design: Retrospective cohort study
Setting: Single Academic Center
Participants: Consecutive cohort of 122 patients with T1 and T2 oropharyngeal cancer undergoing treatment with curative intent and accurate follow-up information
Intervention: Surgery, radiation, and/or chemotherapy for oropharyngeal cancer
Main Outcome and Measure: Chronic opioid use, defined as use of opioid analgesics >90 days following completion of treatment. Factors associated with chronic opioid use were investigated by univariate testing. Clinically relevant factors with p <0.1 on univariate tests were evaluated using multivariable logistic regression.
Results: There were 122 patients that met inclusion criteria. Mean (SD) age was 59.8 (9.1) years and 113 (92.6%) patients were male. The overall prevalence of chronic opioid use was 45.9%. On univariate testing, there was a significant difference in the frequency of chronic opioid use between patients treated non-surgically compared to those that underwent surgical resection (62.9% versus 28.3%, respectively, p= 0.001). On multivariate analysis, primary non-surgical treatment (odds ratio [OR] 4.5, 95% CI, 1.7-11.4), pretreatment opioid use (OR 14.9, 95% CI, 3.5-62.5), the presence of a psychiatric disorder (OR 4.3, 95% CI, 1.03-18.5), current alcohol use (OR 2.6, 95% CI, 1.03-6.5) and younger age (OR 1.1, 95% CI, 1.02-1.11) were significantly associated with chronic opioid use. In terms of age, the risk of chronic opioid use was twice as high (OR 2.1, 95% CI, 1.2-3.7) for a given individual compared to someone 10 years older in our cohort.
Conclusions and Relevance: Opioid use remains common among patients with T1 and T2 oropharyngeal cancer following completion of their treatment. Primary non-surgical treatment was independently associated with an increased risk of chronic opioid use. Additional independent risk factors include younger age, preoperative opioid use, current alcohol use, and the presence of a psychiatric disorder. Preventative strategies should be focused toward these patients to reduce their risk of long term opioid use.