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Ashare RL, Worster B, Nugent SM, Smith DM, Morasco BJ, Leader AE, Case AA, Meghani SH. Cannabis and opioid perceptions, co-use, and substitution among patients across 4 NCI-Designated Cancer Centers. J Natl Cancer Inst Monogr 2024; 2024:267-274. [PMID: 39108237 PMCID: PMC11303867 DOI: 10.1093/jncimonographs/lgad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/20/2023] [Accepted: 08/19/2023] [Indexed: 08/10/2024] Open
Abstract
Prescription opioids are used for managing pain in persons with cancer, however, there are socioeconomic and racial disparities in medication access. Cannabis is increasingly used for cancer symptom management and as an opioid alternative. Limited data are available about patterns of opioid and cannabis use among patients with cancer. We used survey data from 4 National Cancer Institute-designated cancer centers in 3 states (n = 1220) to assess perceptions, use of cannabis and opioids for pain, their substitution, and racial and ethnic differences in each outcome. Compared with White patients, Black patients were less likely to use opioids for pain (odds ratio [OR] = 0.66; P = .035) and more likely to report that cannabis was more effective than opioids (OR = 2.46; P = .03). Race effects were mitigated (P > .05) after controlling for socioeconomic factors. Further research is needed to understand cannabis and opioid use patterns and how overlapping social determinants of health create a disadvantage in cancer symptom management for Black patients.
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Affiliation(s)
- Rebecca L Ashare
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Brooke Worster
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Shannon M Nugent
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Benjamin J Morasco
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Amy E Leader
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy A Case
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Salimah H Meghani
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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2
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Salz T, Meza AM, Bradshaw PT, Jinna S, Moryl N, Kriplani A, R Tringale K, Flory J, Korenstein D, Lipitz-Snyderman A. Role of primary care in opioid prescribing for older head and neck cancer survivors. Cancer 2024. [PMID: 39072710 DOI: 10.1002/cncr.35478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time. METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty. RESULTS Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP. CONCLUSIONS PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn R Tringale
- University of California San Diego School of Medicine, San Diego, California, USA
| | - James Flory
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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3
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Worster B, Meghani SH, Leader AE, Nugent SM, Jones KF, Yeager KA, Liou K, Ashare RL. Toward reducing racialized pain care disparities: Approaching cannabis research and access through the lens of equity and inclusion. Cancer 2024; 130:497-504. [PMID: 37941524 PMCID: PMC11212108 DOI: 10.1002/cncr.35115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long-racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis' deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term "cannabis" here rather than "marijuana.: In the early 1900s, the lay press and government popularized the use of the word "marijuana" instead of the more common "cannabis" to tie the drug to anti-Mexican prejudice.
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Affiliation(s)
- Brooke Worster
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy E Leader
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institution, Oregon Health and Science University, Portland, Oregon, USA
| | - Katie Fitzgerald Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rebecca L Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, New York, USA
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4
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Salz T, Chimonas S, Jinna S, Brens J, Kriplani A, Salner A, Rabinowits G, Currier B, Daly B, Korenstein D. Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis. Pain Manag 2024; 14:87-99. [PMID: 38318666 PMCID: PMC10918509 DOI: 10.2217/pmt-2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Jessica Brens
- Memorial Sloan Kettering Cancer Center, Department of Advanced Practice Providers, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Andrew Salner
- Hartford Hospital, Department of Radiation Oncology, Hartford, CT 06106, USA
| | - Guilherme Rabinowits
- Moffit Cancer Center, Department of Head and Neck-Endocrine Oncology, Tampa, FL 33612, USA
| | - Beatriz Currier
- Miami Cancer Institute, Department of Medicine, Miami, FL 33176, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Deborah Korenstein
- Mount Sinai Hospital, Department of Internal Medicine, New York, NY 10001, USA
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5
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Patel R, Nguyen J, Choudhry HS, Lemdani MS, Park RCW. Opioid prescription trends among American Head and Neck Society fellowship graduates. Head Neck 2023; 45:1113-1121. [PMID: 36859787 DOI: 10.1002/hed.27312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Opioids are commonly used to manage the pain of head and neck (HN) cancer patients. METHODS Retrospective cohort of graduates from American Head and Neck Society accredited fellowships from 1997 to 2018. The Center for Medicare and Medicaid Services Part D Provider Utilization and Payment database 2014-2019 was cross-referenced with provider names to identify opioid prescription trends. RESULTS From 2014 to 2019, there was no significant difference in the average number of opioid beneficiaries per provider (18.02 vs. 18.10, p = 0.586) or opioid claims per provider (28.06 vs. 26.73, p = 0.708). The average total opioid day supply per beneficiary declined from 11.09 to 7.05 days from 2014 to 2019 (p < 0.001). In 2019, providers in the Northeast had the lowest prescribed opioid day supply (3.67 days) compared to those from the South who had the highest (10.32 days). CONCLUSIONS Opioid prescription length has significantly declined among HN surgeons, with variations across geographic regions.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Julia Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mehdi S Lemdani
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Canick JE, Bhardwaj A, Patel A, Kuziez D, Larsen R, Misra S, Pearson B, Smith BD, Rohde RL, Adjei Boakye E, Kahmke RR, Osazuwa-Peters N. Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting. JCO Oncol Pract 2023; 19:e397-e406. [PMID: 36480772 PMCID: PMC10022872 DOI: 10.1200/op.22.00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. METHODS We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. RESULTS Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). CONCLUSION We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.
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Affiliation(s)
- Julia E. Canick
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
| | | | | | - Duaa Kuziez
- Wake Forest School of Medicine, Department of Surgery, Winston-Salem, NC
| | | | | | | | - Blaine D. Smith
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
| | - Rebecca L. Rohde
- Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, Milwaukee, WI
| | - Eric Adjei Boakye
- Henry Ford Health System, Department of Otolaryngology-Head & Neck Surgery, Detroit, MI
- Henry Ford Health System, Department of Population Health Sciences, Detroit, MI
| | - Russel R. Kahmke
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Nosayaba Osazuwa-Peters
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
- Duke Cancer Institute, Durham, NC
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC
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7
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Long-term opioid use in patients treated with head and neck intensity-modulated radiotherapy. Support Care Cancer 2022; 30:7517-7525. [PMID: 35666302 DOI: 10.1007/s00520-022-07155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Acute and chronic pain during and after radiotherapy is an important driver of poor quality of life. We aimed to identify risk factors associated with increased chronic opioid use in head and neck squamous cell cancer survivors. METHODS We performed a retrospective cohort analysis on head and neck squamous cell cancer patients treated with definitive or adjuvant intensity-modulated radiotherapy. We tracked their oncologic opioid prescription profile from initial presentation to the last follow-up date. We determined the incidences of 1- and 2-year opioid use and performed multivariate logistic regression for both outcomes. RESULTS Our analytic cohort consisted of 403 head and neck squamous cell cancer survivors. The numbers of patients requiring opioids at 3 months, 6 months, and 1 year after treatment were 316 (78%), 203 (50%), and 102 (25%), respectively. On multivariate logistic regression, positive smoking history (95% CI 1.86 [1.03, 3.43], p = 0.04), unemployment (95% CI 2.33 [1.16, 4.67], p = 0.02), prior psychiatric illness (95% CI 2.15 [1.05, 4.40], p = 0.03), and opiate use before radiotherapy (95% CI 2.75 [1.49, 5.20], p = 0.01) were independently associated with significantly greater odds of opioid use at 1 year. CONCLUSIONS Our institutional analysis has shown that a substantial amount of head and neck cancer survivors are chronically dependent on opioids following radiotherapy. We have identified a cohort at highest risk for long-term use, for whom early interventions should be targeted.
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8
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Check DK, Avecilla RAV, Mills C, Dinan MA, Kamal AH, Murphy B, Rezk S, Winn A, Oeffinger KC. Opioid Prescribing and Use Among Cancer Survivors: A Mapping Review of Observational and Intervention Studies. J Pain Symptom Manage 2022; 63:e397-e417. [PMID: 34748896 DOI: 10.1016/j.jpainsymman.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Recent years show a sharp increase in research on opioid use among cancer survivors, but evidence syntheses are lacking, leaving knowledge gaps. Corresponding research needs are unclear. OBJECTIVES To provide an evidence synthesis. METHODS We searched PubMed and Embase, identifying articles related to cancer, and opioid prescribing/use published through September 2020. We screened resulting titles/abstracts. Relevant studies underwent full-text review. Inclusion criteria were quantitative examination of and primary focus on opioid prescribing or use, and explicit inclusion of cancer survivors. Exclusion criteria included end-of-life opioid use and opioid use as a secondary or downstream outcome (for intervention studies). We extracted information on the opioid-related outcome(s) examined (including definitions and terminology used), study design, and methods. RESULTS Research returned 16,591 articles; 296 were included. Only 22 of 296 studies evaluated an intervention. There were 105 studies evaluating outcomes indicative of potentially high-risk, nonrecommended, or avoidable opioid use, e.g., continuous use-described as chronic use, prolonged use, and persistent use (n = 17); use after completion of curative-intent treatment-described as chronic opioid use, long-term opioid use, persistent opioid use, prolonged opioid use, continued opioid use, late opioid use, post-treatment opioid use (n = 27); use of opioids concurrent with other potentially high-risk medications (n = 13), and opioid misuse (n = 14). CONCLUSIONS We found lack of consistency in the measurement of and terms used to describe similar opioid use outcomes, and a lack of interventional research targeting well-documented patterns of potentially nonrecommended, potentially avoidable, or potentially high-risk opioid prescribing or use.
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Affiliation(s)
- Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine (D.K.C.), Durham, North Carolina; Duke Cancer Institute, Duke University Medical Cente (D.K.C., R.A.A., C.M., A.H.K., K.C.O.), Durham, North Carolina.
| | - Renee A V Avecilla
- Duke Cancer Institute, Duke University Medical Cente (D.K.C., R.A.A., C.M., A.H.K., K.C.O.), Durham, North Carolina
| | - Coleman Mills
- Duke Cancer Institute, Duke University Medical Cente (D.K.C., R.A.A., C.M., A.H.K., K.C.O.), Durham, North Carolina
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health (M.A.D.), New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (M.A.D.), New Haven, Connecticut
| | - Arif H Kamal
- Duke Cancer Institute, Duke University Medical Cente (D.K.C., R.A.A., C.M., A.H.K., K.C.O.), Durham, North Carolina; Department of Medicine, Duke University Medical Center (A.H.K.), Durham, North Carolina
| | - Beverly Murphy
- Duke University Medical Center Library & Archives, Duke University School of Medicine (B.M.), Durham, North Carolina
| | - Salma Rezk
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy (S.R.), Chapel Hill, North Carolina
| | - Aaron Winn
- School of Pharmacy, Medical College of Wisconsin (A.W.), Milwaukee, Wisconsin
| | - Kevin C Oeffinger
- Duke Cancer Institute, Duke University Medical Cente (D.K.C., R.A.A., C.M., A.H.K., K.C.O.), Durham, North Carolina; Department of Medicine, Duke University School of Medicine (K.C.O.), Durham, North Carolina
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9
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Salz T, Mishra A, Gennarelli RL, Lipitz-Snyderman A, Moryl N, Tringale KR, Boudreau DM, Kriplani A, Jinna S, Korenstein D. Safety of opioid prescribing among older cancer survivors. Cancer 2022; 128:570-578. [PMID: 34633662 PMCID: PMC9377378 DOI: 10.1002/cncr.33963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cancer survivors receive more long-term opioid therapy (LTOT) than people without cancer, but the safety of LTOT prescribing is unknown. METHODS Opioid-naive adults aged ≥66 years who had been diagnosed in 2008-2015 with breast, lung, head and neck, or colorectal cancer were identified with data from Surveillance, Epidemiology, and End Results cancer registries linked with Medicare claims. Survivors with 1 or more LTOT episodes (≥90 consecutive days) occurring ≥1 year after their cancer diagnosis and before censoring at hospice entry, another cancer diagnosis, 6 months before death, or December 2016 were included. The safety of prescribing during the first 90 days of the first LTOT episode was measured during follow-up. As a positive safety indicator, the proportion of survivors with concurrent nonopioid pain management was measured. Indicators of less safe prescribing were the proportion of survivors with a high average daily opioid dose (≥90 morphine milligram equivalents) and the proportion of survivors with concurrent benzodiazepine dispensing. Multivariable logistic regression analyses were conducted to identify clinical predictors of each safety outcome. RESULTS In all, 3628 cancer survivors received LTOT during follow-up (median duration, 4.9 months; interquartile range, 3.5-8.0 months). Seventy-two percent of the survivors received multimodal pain management concurrently with LTOT. Eight percent of the survivors had high-dose opioid prescriptions; 25% of the survivors received benzodiazepines during LTOT. Multivariable analyses identified variations in safety measures by multiple clinical factors, although none were consistently significant across outcomes. CONCLUSIONS To improve safe LTOT prescribing for survivors, efforts should focus on increasing multimodal pain management and reducing inappropriate benzodiazepine prescribing. Different clinical predictors of each outcome suggest different drivers of safe prescribing.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics
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10
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Wang JJ, Rubin SJ, Devaiah AK, Faden DL, Salama AR, Edwards HA. Long-Term Opioid Use in Post-Surgical Management of Patients With Head and Neck Cancer. Ann Otol Rhinol Laryngol 2021; 131:844-850. [PMID: 34521247 DOI: 10.1177/00034894211045771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aims to identify clinical and socioeconomic factors associated with long-term, post-surgical opioid use in the head and neck cancer population. METHODS A single center retrospective study was conducted including patients diagnosed with head and neck cancer between January 1, 2014 and July 1, 2019 who underwent primary surgical management. The primary outcome measure was continued opioid use 6 months after treatment completion. Both demographic and cancer-related variables were recorded to determine what factors were associated with prolonged opioid use. Univariate analysis was performed using chi-squared test for categorical variables and 2-sample t-test for continuous variables. Multivariate analysis was performed using logistic regression. RESULTS A total of 359 patients received primary surgical management. Forty-five patients (12.53%) continued to take opioids 6 months after treatment completion. Using univariate analysis, patients less than 65 years of age (P = .0126), adjuvant chemoradiation (n = 25, P < .001), and overall length of hospital stay (8.60 ± 8.58 days, P = .0274) were significantly associated with long term opioid use. Multivariate logistic regression showed that adjuvant chemoradiation (OR = 3.446, 95% CI [1.742, 6.820], P = .0004) and overall length of hospital stay (OR = 0.949, 95% CI [0.903, 0.997], P = .0373) to be significantly associated with opioid use 6 months after head and neck cancer treatment. CONCLUSION Long-term postoperative opioid use in head and neck cancer patients is significantly associated with adjuvant chemoradiation, and patients with longer length of hospital stay. Therefore, future research should focus on interventions to better manage opioid use during the acute treatment period to decrease long-term use.
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Affiliation(s)
- Judy J Wang
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Samuel J Rubin
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Daniel L Faden
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, USA
| | - Heather A Edwards
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
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11
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Rich BJ, Schumacher LED, Sargi ZB, Masforroll M, Kwon D, Zhao W, Rueda-Lara MA, Freedman LM, Elsayyad N, Samuels SE, Abramowitz MC, Samuels MA. Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single-institution retrospective analysis characterizing patients who did not require opioid therapy. Head Neck 2021; 43:2973-2984. [PMID: 34143542 DOI: 10.1002/hed.26785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/06/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We had previously analyzed the variables that determine the rates of opioid use at 1-year postradiotherapy in patients with head and neck cancer. Here we analyze the variables associated with opioid abstinence during and in the 12 months after radiotherapy at our institution. METHODS We identified a cohort of patients with head and neck cancer who received radiotherapy as part of curative treatment at our institution. Logistic regression analyses were performed to determine socioeconomic and clinical factors associated with opioid abstinence. RESULTS The cohort included 376 patients. On multivariable analysis, patients from an upper-income class (p = 0.004), black race (p = 0.004), older (p = 0.008), with dependent children (p < 0.001) or receiving surgery (p = 0.002) were more likely to abstain from opioids, while patients using analgesic mouthwash (p = 0.009) or higher pain scale (p = 0.002) were less likely. CONCLUSION Socioeconomic and treatment characteristics are associated with opioid abstinence during and following radiation treatment in patients with head and neck cancer.
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Affiliation(s)
- Benjamin J Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leif-Erik D Schumacher
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Deukwoo Kwon
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wei Zhao
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria A Rueda-Lara
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laura M Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuart E Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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