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Patients with head and neck cancer more likely to be prescribed opioids
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Patients with head and neck cancers appeared significantly more likely to receive opioid prescriptions than those who had lung cancer or colon cancer, according to a published research letter.
“Head and neck cancer pain represents a significant physical, psychological and financial burden for patients,” Rosh K.V. Sethi, MD, MPH, of the department of otolaryngology at Harvard Medical School, and colleagues wrote in JAMA Otolaryngology-Head & Neck Surgery. “Opioids remain a mainstay of treatment for these patients, and head and neck oncologists must balance the goal of optimal pain control with the risks of abuse. Current literature has not thoroughly characterized opioid prescription patterns among patients with head and neck cancer.”
The researchers conducted a cross-sectional analysis of the Prescription Medicine Files — part of the Medical Expenditures Survey conducted each year by the Agency for Healthcare Research and Quality — for the years 2011, 2013 and 2015.
Sethi and colleagues searched the database to assess the proportion of opioid prescriptions, mean payment per opioid prescription, duration of prescription and quantity of opioid prescriptions for patients with head and neck cancer, lung cancer or colon cancer.
The researchers identified 739 prescriptions in the analysis (n = 168 for head and neck cancer; n = 571 for lung or colon cancer).
Patients who had head and neck cancers had a significantly higher likelihood of being prescribed opioids than those who had lung or colon cancers (OR = 1.68; 95% CI, 1.13-2.49). Among patients prescribed oxycodone, those with head and neck cancer received a greater number of tablets than those who had lung cancer or colon cancer (mean, 87.1 vs. 71), although the researchers noted that “the standardized mean difference was highly variable” (Cohen d = 0.25; 85% CI, –10.9 to 11.36).
Researchers reported no difference between groups with regard to duration of drug supply or mean payment per prescription for opioids.
Sethi and colleagues acknowledged study limitations, including a lack of information about prior oncologic treatment, tumor stage and location, as well as possible comorbid chronic pain conditions.
“It is imperative that head and neck cancer physicians are mindful of opioid prescription trends for patients with head and neck cancer, especially in the context of the current opioid epidemic,” they wrote. “There is an urgent need for further quantification and understanding of postprocedural and chronic opioid use in this patient population.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Sethi and colleagues determined head and neck cancer diagnoses appeared associated with significantly greater number of opioid prescriptions than lung or colon cancer diagnoses.
The study results are not particularly surprising, given the fact patients with head and neck cancer experience pain both due to underlying disease and treatment side effects, especially in the setting of concomitant chemotherapy and radiation treatment. It also is important to consider the fact that uncontrolled pain in this population often has consequences beyond suffering and poor quality of life. These include malnutrition, dehydration and swallowing dysfunction. This undoubtedly contributes to higher opioid utilization.
In addition, patients who receive multimodal therapy for their cancer may receive opioid prescriptions from multiple providers, such as medical oncology and radiation oncology specialists. This may contribute to the increased number of opioid prescriptions described in this study.
These findings are relevant in light of the opioid epidemic, and extra caution should be exercised when prescribing opioids for this population to reduce overdose risk. Prior to initiation of opioid therapy, clinicians may use the opioid risk tool to assess a patient’s risk for opiate misuse. If the patient has a moderate to severe score, referral to a palliative medicine or pain management specialist would provide extra support for the treating clinician.
Another way to mitigate opioid misuse concerns is to ensure that only one provider or team manages a patient’s opioids. This is especially important for oncology patients who receive simultaneous treatment from multiple providers, as is the case for patients with head and neck cancers who receive concomitant chemotherapy and radiation therapy.
Finally, utilization of prescription monitoring programs allows clinicians to review controlled substance prescriptions to help ensure that patients only receive opioids from one source. These programs will report all controlled substances, including benzodiazepines — which, when used with opioids, contribute to accidental overdose.
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