Predictors of Long-Term Opioid Treatment Among Patients Who Receive Chemoradiation for Head and Neck Cancer
Menée auprès de 70 patients atteints d'un cancer de la tête et du cou, cette étude américaine analyse les facteurs associés à la prise continue d'un traitement à base d'opioïdes trois mois après une radiothérapie avec ou sans chimiothérapie
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.