Opiate Use in Patients Undergoing Adjuvant Therapy for Oral Cavity Cancer

Abstract

In the context of the opiate epidemic, there is value to examine the use of opioids in specific cancer patient cohorts. We analyzed opioid use in patients undergoing adjuvant radiotherapy with or without concurrent systemic therapy following surgery for oral cavity cancer. We sought to define the prescribing patterns of opiates in this patient cohort. We performed a retrospective IRB-approved analysis of opioid prescribing patterns on patients identified in our institutional head and neck cancer registry who received adjuvant radiotherapy for resected oral cavity squamous cell carcinomas between 2003 and 2016. Patients were categorized as opioid “naïve,” “intermittent,” or “chronic” users of opioids, using previously published criteria. Narcotic use specifically associated with cancer treatment was defined as prescriptions within 30 days pre-operatively, as well as those during and immediately after radiotherapy. Persistent use was defined as consecutive prescriptions for opioids, dated no longer than 2 months apart. Chi-square test and Pearson’s correlation statistic were used to test independence and identify strength of association between patient factors and opioid use, respectively. The Kaplan-Meier method was used to estimate overall survival. We identified 77 patients with oral cavity squamous cell carcinomas who underwent surgery and completed adjuvant radiotherapy with documented opioid data. The vast majority were opioid naïve (69 patients), with fewer intermittent and chronic users (6 and 2 patients, respectively). The percentage of patients with persistent opioid use at 3 months or greater following completion of radiotherapy was 13%. A strong positive correlation between the number of consecutive narcotic scripts and the number of narcotic providers was identified (Pearson’s correlation statistic, r = 0.86; p<0.001). There was also an association between being a naïve, intermittent, or chronic opioid user, and the number of prescriptions written and duration of opioid usage. The median duration of opioid usage for this cohort was 54 days. Estimated overall survival at 3 years was similar at 70% (p=0.87) for those patients prescribed opioids 90 days following completion of radiotherapy and those that were not. Patients receiving opioid prescriptions at 3 months or greater post-completion of adjuvant radiotherapy was similar to reported data for those receiving surgery alone. Increasing numbers of prescribers was associated with increased opioid prescriptions. In conclusion, these data suggest that a minority of patients remain on opioids long-term following completion of adjuvant radiotherapy. The positive correlation between increasing providers with increasing prescriptions provides the opportunity to evaluate the consolidation of prescribers to limit over-prescribing of opioids in this patient cohort.