Cancer Prevention in the Survivorship Setting

Use and Perceptions of Opioids Versus Marijuana among Cancer Survivors

Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients' perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.

Model of an Advanced Practice Provider-Led Head and Neck Cancer Survivorship Clinic: Evaluation of a 4-Year Experience

OBJECTIVE

To report the efficacy and safety of an advanced practice provider-led head and neck cancer survivorship clinic.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary academic medical center.

METHODS

Patients were enrolled into the survivorship clinic after undergoing 1-year follow-up with the primary head and neck surgeon. Those enrolled between December 2016 and October 2020 were retrospectively reviewed for diagnosis, staging, pattern of recurrence, visit frequency, and compliance. Surgical respectability of recurrent disease was used as a surrogate for timely diagnosis.

RESULTS

An overall 570 patients were followed within the survivorship clinic. The mean length of follow-up was 13.6 months. Mucosal primaries represented 72.6% of patients. A majority of the primary malignancies were squamous cell carcinoma (77.7%). The most common primary subsites were the oropharynx (26.7%), oral cavity (25.1%), cutaneous (17.0%), and larynx (15.3%). Recurrence was detected in 50 patients (8.8%): 26 local, 12 regional, and 14 distant. Two patients had multiple synchronous recurrences. Twelve (2.1%) second primary cancers were detected. Of the 36 cases of locoregional recurrence, 32 (88.9%) were deemed amenable to salvage surgical intervention, with or without adjuvant therapy. Negative margins were obtained in 21 of the 23 (91.3%) local recurrences that underwent salvage resection.

CONCLUSION

Advanced practice provider-based surveillance of head and neck cancer, without risk stratification, appears to be a sound model but needs further prospective evaluation. Consistent with literature, 88.9% of patients with locoregional recurrence were candidates for curative-intent salvage surgery, emphasizing that recurrences are identified in a timely fashion.

Use and Perceptions of Opioids versus Marijuana among People Living with HIV

Objectives: In this study, we examined use of and interest in using opioids and marijuana, particularly in relation to use motives and perceived barriers to use, among people living with HIV (PLWH). Methods: We analyzed online survey data from 304 PLWH in the United States recruited via social media in Summer 2018. Results: In this sample (Mage = 30.86, 40.5% male, 64.5% white), 16.1% reported current (past 30-day) use of opioids, 18.1% marijuana, and 15.8% both. Participants reported more use motives and fewer barriers to using marijuana versus opioids (p's < .001). The most frequently endorsed motive for using either/both drugs were to cope with pain and stress/anxiety. Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and addiction concerns. Regression analyses indicated that current opioid use correlated with reporting greater opioid use motives; among past-month opioid nonusers, greater interest in using opioids correlated with greater opioid use motives. Current marijuana use correlated with reporting greater marijuana use motives and greater barriers; among past-month marijuana nonusers, greater interest in using marijuana correlated with greater marijuana use motives and fewer barriers. Conclusions: Use motives and barriers differentially correlated with use and interest in use across drugs, thereby indicating different intervention approaches to address appropriate use.