Background: At the time of diagnosis, significant pain is reported in up to 85% of head and neck cancer patients. The cancer itself, acute toxicities from treatment and long-term treatment side effects can result in pain. Opioids are the cornerstone of treatment regimens for both acute and chronic pain management in patients with head and neck cancer. As overall survival for oropharyngeal squamous cell carcinoma (OPSCC) patients has increased, so has the long-term use of opioids. In the setting of the current opioid abuse epidemic in the United States, another layer of complexity is added to chronic pain management in the head and neck cancer population.
Objectives: 1) Describe the characteristics of opioid use in patients undergoing radiation (RT) or chemoradiation therapy (CRT) for oropharynx cancer. 2) Identify risk factors that are associated with chronic opioid use.
Methods: A retrospective review was conducted for 199 eligible patients undergoing radiation RT or CRT as primary treatment for oropharynx cancer (tonsil and tongue base) at the University of Florida from 2012-2017. p16/HPV status was determined based on review of pathology reports. Chronic opioid use (defined as the use of opioid medication 3 months post-treatment) was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use.
Results: 89% (177) of patients were male with an average age of 62 years and mean follow-up of 31 months. The majority of the patients had stage III/IV disease (83%) and received CRT as primary treatment (73%). 18% received RT alone, and 9% received surgery prior to adjuvant treatment. The majority (69%) were p16 positive, and 73% were former or current smokers. 57 (29%) patients had pre-existing chronic pain conditions. Chronic opioid use was observed in 53% (105) of the patients. Age ≤ 62 years (p<0.0001), history of depression (p=0.0356), p16 negative status (p=0.0097), opioid use at pre-treatment visit (p=0.0021), and presence of a pre-existing chronic pain condition at time of diagnosis (p=0.0181) were associated with chronic opioid use.
Conclusion: More than 50% of the patients treated with radiation for OPSCC in this cohort were chronic opioid users after treatment. Significant predictors for chronic opioid use included pre-treatment opioid use, history of depression, age ≤ 62, p16/HPV negative tumor status and presence of a pre-existing chronic pain condition. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long-term pain management in this patient population.