Do patients with head and neck cancer get more opioids?

Patients diagnosed with head and neck cancer were significantly more likely to be prescribed opioid medications than patients diagnosed with lung or colon cancer in a new study, published in a research letter on March 8 in JAMA Otolaryngology -- Head and Neck Surgery.

Researchers from Harvard University and Duke University compared prescriptions for opioid pain medications given to patients diagnosed with head and neck cancer with those given to patients with lung or colon cancer. They also looked at how many oxycodone tablets were given to each group of patients.

"It is imperative that head and neck cancer physicians are mindful of opioid prescription trends for patients with [head and neck cancer], especially in the context of the current opioid epidemic," the study authors wrote (JAMA Otolaryngol Head Neck Surg, March 8, 2018).

The lead study author was Rosh Sethi, MD, MPH, of the department of otolaryngology at Harvard Medical School in Boston.

More prescriptions, more tablets

There is a lack of information about opioid prescription patterns for patients diagnosed with head and neck cancer, the researchers noted. They wanted to quantify the use of opioid analgesics among these patients and compare this with use among patients diagnosed with lung or colon cancer.

The researchers conducted a retrospective, cross-sectional analysis of the Prescribed Medicines Files from the Medical Expenditure Panel Survey from the years 2011, 2013, and 2015. The survey is conducted each year by the U.S. Agency for Healthcare Research and Quality. The researchers chose data from every other year because each dataset includes a two-year sampling period.

The researchers found a total of 739 opioid prescriptions for these diagnoses, with 168 for patients with head and neck cancer and 571 for patients with lung or colon cancer. Patients with head and neck cancer had significantly greater odds of being prescribed an opioid than patients with lung or colon cancer (95% confidence interval: 1.13 to 2.39) (see table below).

Patients with head and neck cancer were also prescribed a greater quantity of oxycodone tablets compared with those with lung or colon cancer (see table below), although the authors noted a wide variation in quantities. The researchers found no difference in mean duration of supply or mean payment per opioid prescription between the patient groups.

Pain prevalence

The study was limited by the lack of data about previous oncologic treatment, tumor stage, tumor location, and comorbid chronic pain conditions, according to the authors.

As to why patients diagnosed with head and neck cancer need a more intensive pain management regimen, they noted a previous study that found that these patients have a higher prevalence of pain than patients with other cancer types. However, in another study, long-term opioid use was associated with significantly decreased disease-free survival in patients who underwent surgery for oral cancer. In addition, past research has shown a significant link between physician prescribing patterns and overdose risk among cancer patients receiving opioid therapy.

"Indeed, opiate use is not without risk, and achieving adequate pain management while minimizing the risk of substance overuse and misuse is critical," concluded the authors. "There is an urgent need for further quantification and understanding of postprocedural and chronic opioid use in this patient population."