University of Florida Researchers Investigate Chronic Opioid Use in Patients with Head and Neck Cancer

At a time when overdose deaths from prescription and non-prescription opioids have reached epidemic proportions, researchers at the University of Florida College of Medicine’s Department of Otolaryngology — part of UF Health, the Southeast’s most comprehensive academic health center — have taken a closer look at chronic opioid use in patients with oropharyngeal squamous cell carcinoma. The retrospective analysis, which will be published in Laryngoscope in early 2019, found that an alarming number of patients were chronic opioid users three months after treatment.

Nearly 52,000 people are diagnosed with cancer of the oral cavity and pharynx each year in the United States. According to Natalie Silver, M.D., M.S., an assistant professor in the division of head and neck oncologic surgery at UF, “Up to 85 percent of patients with head and neck cancer report significant pain at the time of diagnosis. Opioids are the cornerstone of treatment for both acute and chronic pain management for these patients.” The current opioid crisis in the United States, where more than 100 people die every day from an opioid overdose, highlighted the need to look at long-term opioid use in this patient cohort.

Investigators retrospectively studied 198 patients who underwent curative radiotherapy for oropharynx cancer at UF Health from 2012-2017. They found that more than 50 percent of the patients treated with radiation in this cohort continued to use opioids three months after the conclusion of treatment. These data were presented at the American Head and Neck Society 2018 Annual Meeting.

Silver and her colleagues found significant predictors for chronic opioid use to be pre-treatment opioid use, history of depression, age ≤ 62 and presence of a pre-existing chronic pain condition. Human papillomavirus, or HPV, and p16, a surrogate marker for HPV, negative tumor status also was a predictor.

This study serves as the foundation for additional research to better define at-risk patients and to identify strategies to manage patients’ pain without increasing the risk of chronic opioid use.