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Table.  Summary of Data on Opioid Prescription Patterns in Head and Neck Cancer (HNCA) and Lung or Colon Cancer (LCCA)
Summary of Data on Opioid Prescription Patterns in Head and Neck Cancer (HNCA) and Lung or Colon Cancer (LCCA)
1.
Ing  JW.  Head and neck cancer pain.  Otolaryngol Clin North Am. 2017;50(4):793-806.PubMedGoogle ScholarCrossref
2.
van den Beuken-van Everdingen  MH, de Rijke  JM, Kessels  AG, Schouten  HC, van Kleef  M, Patijn  J.  Prevalence of pain in patients with cancer: a systematic review of the past 40 years.  Ann Oncol. 2007;18(9):1437-1449.PubMedGoogle ScholarCrossref
3.
Pang  J, Tringale  KR, Tapia  VJ,  et al.  Chronic opioid use following surgery for oral cavity cancer.  JAMA Otolaryngol Head Neck Surg. 2017;143(12):1187-1194. doi:10.1001/jamaoto.2017.0582PubMedGoogle ScholarCrossref
4.
Bohnert  ASB, Valenstein  M, Bair  MJ,  et al.  Association between opioid prescribing patterns and opioid overdose-related deaths.  JAMA. 2011;305(13):1315-1321.PubMedGoogle ScholarCrossref
Research Letter
April 2018

Opioid Prescription Patterns Among Patients With Head and Neck Cancer

Author Affiliations
  • 1Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
  • 3Duke University School of Medicine, Durham, North Carolina
JAMA Otolaryngol Head Neck Surg. 2018;144(4):382-383. doi:10.1001/jamaoto.2017.3343

Head and neck cancer (HNCA) pain represents a significant physical, psychological, and financial burden for patients.1 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.1 Current literature has not thoroughly characterized opioid prescription patterns among patients with HNCA. The objective of this study is to quantify the use of opioid analgesics among patients with HNCA and compare this with use among patients with lung or colon cancer (LCCA).

Methods

A retrospective cross-sectional analysis of the 2011, 2013, and 2015 Prescription Medicines Files, published as part of the Medical Provider Component of the Medical Expenditures Panel Survey (MEPS), was performed. MEPS is a nationally representative survey of households conducted annually by the Agency for Healthcare Research and Quality that provides an assessment of health care utilization. Every other year was selected, given sampling period of 2 years per published data set. Massachusetts Eye and Ear Infirmary exempted the study from institutional review board approval.

The database was queried for all prescription events associated with an existing diagnosis of HNCA (Clinical Classification Software [CCS] code 011), as well as lung cancer (CCS 019) and colon cancer (CCS 014). The proportion of prescriptions that were opioids, mean payment per opioid prescription, duration of supply, and quantity of opioid prescribed were quantified and compared between HNCA and LCCA cohorts. Effect sizes were calculated using standardized difference for means (Cohen d) and odds ratio for proportions.

Results

A total of 739 prescriptions associated with HNCA (n = 168) and LCCA (n = 571) diagnoses during the study period were identified and included in the analysis. Patients with HNCA were at significantly greater odds of being prescribed an opioid than patients with LCCA (odds ratio [OR], 1.68; 95% CI, 1.13-2.49). In addition, a greater quantity of oxycodone tablets was provided per prescription for HNCA (mean [SD], 87.1 [82.4] tablets) compared with LCCA (mean [SD], 71.0 [56.3] tablets), although the standardized mean difference was highly variable (Cohen d = 0.25; 95% CI, −10.9 to 11.36). There was no difference in mean duration of supply or mean payment per opioid prescription between the 2 groups (Table).

Discussion

Head and neck cancer diagnoses were associated with significantly greater odds of opioid prescription. Data suggest that patients with HNCA have a higher prevalence of pain than patients with other cancer types, which may explain a necessity for more intensive pain management regimens.2 In a study of patients undergoing surgery for oral cancer, long-term use of opioids was associated with significantly decreased disease-free survival.3 Furthermore, there is a significant correlation between physician prescribing patterns and risk of overdose among patients with cancer receiving opioid therapy.4 Indeed, opiate use is not without risk, and achieving adequate pain management while minimizing the risk of substance overuse and misuse is critical.

It is imperative that head and neck cancer physicians are mindful of opioid prescription trends for patients with HNCA, especially in the context of the current opioid epidemic. This study provides preliminary insight into opioid prescription behaviors; however, it is limited by the absence of prior oncologic treatment, tumor stage, and location, as well as comorbid chronic pain conditions. There is an urgent need for further quantification and understanding of postprocedural and chronic opioid use in this patient population.

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Article Information

Corresponding Author: Rosh K. V. Sethi, MD, MPH, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (rosh_sethi@meei.harvard.edu).

Accepted for Publication: December 19, 2017.

Published Online: March 8, 2018. doi:10.1001/jamaoto.2017.3343

Author Contributions: Dr Sethi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Sethi, Varvares.

Acquisition, analysis, or interpretation of data: Sethi, Panth, Puram.

Drafting of the manuscript: Sethi, Panth.

Critical revision of the manuscript for important intellectual content: Sethi, Puram, Varvares.

Statistical analysis: Sethi.

Administrative, technical, or material support: Sethi.

Study supervision: Sethi, Puram, Varvares.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

Additional Information: Dr Sethi and Ms Panth contributed equally to the study.

References
1.
Ing  JW.  Head and neck cancer pain.  Otolaryngol Clin North Am. 2017;50(4):793-806.PubMedGoogle ScholarCrossref
2.
van den Beuken-van Everdingen  MH, de Rijke  JM, Kessels  AG, Schouten  HC, van Kleef  M, Patijn  J.  Prevalence of pain in patients with cancer: a systematic review of the past 40 years.  Ann Oncol. 2007;18(9):1437-1449.PubMedGoogle ScholarCrossref
3.
Pang  J, Tringale  KR, Tapia  VJ,  et al.  Chronic opioid use following surgery for oral cavity cancer.  JAMA Otolaryngol Head Neck Surg. 2017;143(12):1187-1194. doi:10.1001/jamaoto.2017.0582PubMedGoogle ScholarCrossref
4.
Bohnert  ASB, Valenstein  M, Bair  MJ,  et al.  Association between opioid prescribing patterns and opioid overdose-related deaths.  JAMA. 2011;305(13):1315-1321.PubMedGoogle ScholarCrossref
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