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Predictors of Long-Term Opioid Treatment Among Patients Who Receive Chemoradiation for Head and Neck Cancer.

Predictors of Long-Term Opioid Treatment Among Patients Who Receive Chemoradiation for Head and Neck Cancer.

Oncologist. 2013 May 30;

Authors: Kwon JH, Hui D, Chisholm G, Bruera E

Abstract
INTRODUCTION: The factors associated with successful opioid discontinuation after cancer treatment are not well-known. We determined the proportion of patients with advanced head and neck cancer who continued using opioids 3 months after the completion of radiation therapy with or without chemotherapy. METHODS: We included 70 patients with head and neck cancer referred to our institution’s supportive care center between January 1, 2008, and December 31, 2010. Patients who no longer used opioids 3 months after the completion of radiation therapy were classified as stoppers; patients who continued using opioids were considered nonstoppers. We compared demographics, cancer-related characteristics, alcoholism, substance abuse history, use of psychoactive drugs, and opioid-related factors between stoppers and nonstoppers. RESULTS: In all, 44 of 70 patients (63%) and 23 of 70 patients (33%) continued opioids 3 months and 6 months after the completion of radiation therapy, respectively. A total of 18 of 44 nonstoppers (41%) and 3 of 26 stoppers (12%) were positive for alcoholism based on the CAGE questionnaire (i.e., Cut down, Annoying, Guilty, Eye opener; odds ratio: 5.3). Demographic and clinical characteristics did not differ between stoppers and nonstoppers. The median duration of any type of opioid use of CAGE-positive patients was significantly longer than that of CAGE-negative patients (median: 261 days vs. 93 days; hazard ratio: 2.5). CONCLUSION: CAGE positivity is a risk factor for opioid use beyond 3 months after the completion of radiation therapy and for duration of opioid treatment. Routine CAGE screening and meticulous follow-up are needed for these patients.Patients with head and neck cancer receiving chemoradiation suffer from side effects of treatment, especially pain. Severe pain is usually managed with opioids; however, in cancer survivors, specific groups of patients with risk factors cannot take opioids even to resolve treatment-related side effects. In this study, 63% and 33% of patients still used opioids 3 months and 6 months after the completion of radiation therapy, respectively. Patients who continued opioids at 3 months had higher positive CAGE than those who stopped opioids. CAGE-positive patients had longer median overall survival than CAGE-negative patients. Routine screening of CAGE for alcoholism, careful assessment of pain syndrome, longitudinal monitoring, and psychological intervention are needed for these patients.

PMID: 23723332 [PubMed – as supplied by publisher]

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