Long-Term Opioid Use Following Radiation or Chemoradiation for Head and Neck Cancer

Patients with head and neck cancer represent a vulnerable patient population for potential chronic opioid use. Prior institutional studies on chronic opioid use had limited sample sizes, and the incidence of and risk factors for chronic opioid use need further investigation.

To evaluate the proportion of patients with opioid use and factors associated with opioid use 3 months following chemoradiation or radiation treatment for head and neck cancer.

This single-institution cohort study at The Ohio State Comprehensive Cancer Center included patients diagnosed with nonmetastatic head and neck cancer between October 2011 and December 2023 who received definitive radiation or chemoradiation.

Receipt of definitive radiation or chemoradiation.

The primary end point was opioid use 3 months after completing radiation in the entire cohort. Logistic multivariable analysis was performed to evaluate variables associated with opioid use at this time point. Secondary end points were opioid use at 6 months and time to first opioid use in an opioid-naive patient subgroup.

A total of 789 patients met the study's inclusion criteria (639 men [81.0%]; median age, 61 years [IQR, 55-68 years]). Median follow-up was 46.7 months (IQR, 31.1-56.1 months). Between diagnosis and 6 months following radiation, 750 patients (95.1%) received prescription opioids. At 3 and 6 months following radiation, 552 (70.0%) and 373 (47.3%) patients, respectively, continued taking prescription opioids. Patients were more likely to be taking opioids at 3 months following radiation if they were former smokers (adjusted odds ratio [AOR], 1.55; 95% CI, 1.04-2.31), were referred to palliative care (AOR, 3.90; 95% CI, 2.57-6.09), or had taken opioids prior to radiation (AOR, 2.57; 95% CI, 1.82-3.63). Among 296 patients who were opioid-naive prior to radiation (37.5%), time to first opioid use was shorter for those with underweight status (adjusted hazard ratio [AHR], 7.36; 95% CI, 3.40-15.90) and those referred to palliative care (AHR, 1.42; 95% CI, 1.10-1.83). Of the opioid-naive patients, 171 (57.8%) and 112 (37.8%) continued taking opioids at 3 and 6 months following radiation, respectively.

In this cohort study, 70.0% and 47.3% of patients with head and neck cancer continued taking opioids at 3 and 6 months following treatment, respectively. Factors associated with opioid use at 3 months included prior opioid use, former smoking status, and palliative care referral. These findings suggest that targeted opioid stewardship programs that consider both analgesia and long-term dependency risk are merited.