Chronic opioid therapy among a high-risk cancer survivor population.

Abstract

e19107 Background: Head and neck cancer (HNC) survivors are at increased risk of opioid dependence, due to exposure to opioids during treatment, history of tobacco and alcohol use, and substantial pain after treatment. Chronic opioid therapy (COT) is a risk factor for dependence, and rates of COT vary widely between populations of cancer survivors. We hypothesized that COT use is greater among HNC survivors than among those who never had cancer. Methods: We used SEER-Medicare to identify adults ≥66 years diagnosed with HNC between 2008 and 2015. HNC survivors were matched 1:3 at date of diagnosis on age, sex, comorbidity, and region with cancer-free controls. Survivors and controls had complete coverage with fee-for-service Medicare Parts A, B, and D for each year after matching. Survivors and controls with no COT in the year prior to matching date and were followed for COT use through 2016. The presence of claims for opioid dispensings over ≥90 consecutive days (COT) was calculated for each year after cancer diagnosis among survivors alive at the start of each year and for controls. We computed odds ratios (OR) for COT use for HNC survivors compared to matched controls in each year after matching date, using a hierarchical logistic regression model accounting for matching and repeated measurements across years. Results: The population of HNC survivors declined from 5,107 in the year after diagnosis to 604 in Year 6. Among HNC survivors, COT use remained relatively steady each year after diagnosis. (Table). For the first 5 years after matching date, rates of COT among HNC survivors exceeded that of controls, with the difference between survivors and controls declining each year (OR 4.36 for Year 1, OR 2.60 for Year 2, OR 2.18 for Year 3, OR 1.85 for Year 4, and OR 1.35 for Year 5, all p-values < 0.05). By Year 6, rates of COT use did not differ between HNC cases and controls. Conclusions: In the first year after diagnosis, HNC survivors have more than 4 times the odds of COT use compared to cancer-free controls. Cancer-associated COT use declines over time. Strategies for appropriate pain management for HNC survivors should balance the risk of opioid dependence, particularly in the early years after diagnosis, with the benefit of improved comfort and function. [Table: see text]