Preexisting Psychiatric Risk Factors and Any and Long-Term Opioid Use in Head and Neck Cancer

Area of Science:

• Oncology
• Psychiatry
• Pharmacology

Background:

• Head and neck cancer (HNC) is associated with significant psychiatric distress.
• Opioid use is common in cancer care, but its link with psychiatric factors in HNC is not well understood.

Purpose of the Study:

• To investigate the association between preexisting psychiatric risk factors and opioid prescription use in HNC patients.
• To determine if these factors predict any opioid prescription or long-term opioid therapy (LTOT).

Main Methods:

• Retrospective longitudinal cohort study using electronic health records (Optum database, 2010-2018).
• Included adult HNC patients without prior opioid use, analyzing 2-year look-back data.
• Multivariate logistic regression assessed associations between psychiatric factors (depression, nicotine dependence, etc.) and opioid use (any prescription or LTOT within 12 months of HNC diagnosis).

Main Results:

• Of 11,335 eligible HNC patients, 23.4% received opioid prescriptions and 4.9% received LTOT within 12 months.
• Depression (aOR, 1.21), nicotine dependence (aOR, 1.56), and benzodiazepine use (aOR, 1.44) were linked to higher odds of any opioid prescription.
• Nicotine dependence (aOR, 1.77) was the only psychiatric factor associated with increased odds of LTOT.

Conclusions:

• Preexisting psychiatric comorbidities, particularly depression and nicotine dependence, are associated with increased opioid prescription and LTOT in HNC patients.
• Screening for these conditions is crucial for informed clinical decision-making and safer opioid prescribing in HNC management.