While head and neck cancer patients often receive pain medications during recovery from surgery, the use of opioids could be a gateway to misuse or addiction once treatment ends, especially as cancer patients live longer than ever before.
“We felt like it was a long-term problem for some of our head and neck cancer patients but didn’t know how much of a problem,” said Jessica McDermott, MD, an investigator at the University of Colorado (CU) Cancer Center and assistant professor at the CU School of Medicine.
McDermott and her colleagues found that 811 of 976 patients treated between 2008 and 2011 for oral and oropharynx cancer, as identified in the SEER/Medicare database, received opioid prescriptions during treatment.
Three months after treatment ended, 150 of them continued to have active opioid prescriptions. Six months after treatment, 68 patients or 7% of the total population continued to use opioid pain medications.
“You shouldn’t need opioids at the six-month point,” said McDermott. “We hope that we can use this data to help patients manage pain better.”
Since younger patients in this and other studies were at greater risk for opioid misuse, and the SEER/Medicare database is heavily skewed to include data from older patients, McDermott suggests that the true percentage of opioid misuse in the overall head and neck cancer patient population is likely higher than the study suggests.
Additional risk factors for continued opioid use included opioid prescription prior to cancer treatment and a history of smoking and/or alcohol use.
Also, patients prescribed oxycodone as their first opiate were less likely to continue use at three and six months after treatment than patients initially prescribed hydrocodone or other opiates including fentanyl, hydromorphone, meperidine hydrochloride, morphine, nalbuphine, or tramadol.
“We don’t know why this is the case, but we think that maybe patients know the word ‘oxycodone’ and are more aware of the potential for addiction than they might be if prescribed a less well-known drug or one they consider less dangerous like hydrocodone,” said McDermott.
The researchers see the current study as a way to understand the ecosystem of pain control and opioid dependence in head and neck cancer patients, with the goal of working to change doctors’ strategies for pain control.
“If a patient needed opioids for pain, I wouldn’t keep them away. But especially if they have risk factors, I might counsel them more about the risks of addiction and misuse and keep an eye on it,” said McDermott.
The study, “Short- and Long-term Opioid Use in Patients with Oral and Oropharynx Cancer,” was published by Otolaryngology-Head and Neck Surgery.
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