Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: The incidence of persistent opioid use in head and neck cancer survivors is high, even in comparison to other cancer demographics. Risk factors for persistent opioid use are poorly understood.
Objective: The objective was to evaluate the incidence and risk factors for persistent opioid use diagnosed within 1 year postoperatively in patients undergoing resection of an oral cavity squamous cell carcinoma.
Design, Setting, and Participants: Retrospective cohort study of all patients undergoing resection of an oral cavity squamous cell carcinoma at tertiary care cancer center between 2016 and 2022.
Main Outcome and Measures: The primary predictor variable was preoperative opioid use. Subjects were stratified into opioid naïve, intermittent opioid users, and chronic opioid users based on pharmacy claims from the State government Prescription Drug Monitoring Program. The primary outcome variable was persistent opioid use, defined as patients who 1) filled an opioid prescription attributed to surgery and; 2) filled two consecutive opioid prescriptions between 120 to 365 days after surgery, allowing for one week between prescriptions. Univariate analysis was performed to evaluate the relationship between covariates and persistent opioid use. A mixed effects regression model was generated to identify independent predictors of persistent opioid use.
Results: During the study period there were 430 subjects that met inclusion and exclusion criteria. The final cohort had a mean age of 62.6 years, was 55.8% male, and 86.0% White. Most subjects were opioid naïve (50.0%) or intermittent users (36.7%) with few chronic users (13.3%). During the study period, 81 subjects filled a postoperative opioid prescription and met criteria for persistent opioid use for an overall incidence of 18.8%. The incidence of persistent opioid use increased with greater preoperative opioid use with an incidence of 10.7% in the opioid naïve, 15.2% in intermittent opioid users, and 59.6% in chronic opioid users. In persistent opioid users, the median number of filled opioid scripts was 8.00. Persistent opioid use was most likely to occur 120 to 180 days after surgery and declined with time regardless of preoperative opioid status or undergoing adjuvant therapy. Chronic opioid use (OR = 17.9, 95% CI = 1.61 – 199, p = 0.019), chronic pain diagnosis (OR = 4.63, 95% CI = 1.07 – 20.0, p = 0.040), and recurrence within 12 months (OR = 7.14, 95% CI = 1.21 – 42.3, p = 0.030) were independent predictors of persistent opioid use. Adjuvant radiotherapy (OR = 3.39, 95% CI = 0.75 – 15.3, p = 0.112) and chemoradiotherapy (OR = 4.36, 95% CI = 0.67 – 28.6, p = 0.125) increased the odds of persistent opioid use but did not reach statistical significance.
Conclusions and Relevance: The incidence of persistent opioid use within a year postoperatively was 18.8% and scripts were prescribed most frequently 120 to 180 days after surgery. Chronic preoperative opioid use was the strongest independent risk factor for persistent opioid use followed by recurrence and a history of a chronic pain diagnosis.