接受口咽癌治疗的患者中慢性阿片类药物的使用情况。
Chronic opioid use in patients undergoing treatment for oropharyngeal cancer.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Gainesville, Florida, U.S.A.
University of Florida, Gainesville, Florida, U.S.A.
出版信息
Laryngoscope. 2019 Sep;129(9):2087-2093. doi: 10.1002/lary.27791. Epub 2019 Jan 6.
OBJECTIVES/HYPOTHESIS: Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use.
STUDY DESIGN
Retrospective cohort study.
METHODS
A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival.
RESULTS
The average age was 62 years, and the mean follow-up was 38 months. Eighty-three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty-nine percent were HPV/p16 positive. Fifty-seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration.
CONCLUSIONS
More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long-term pain management in this patient population.
LEVEL OF EVIDENCE
4 Laryngoscope, 129:2087-2093, 2019.
目的/假设：头颈部癌症疼痛是一个普遍存在的问题，而当前的阿片类药物危机凸显了慢性疼痛管理中存在的问题。本研究评估了接受口咽癌治疗的患者使用阿片类药物的特征，并确定了与慢性阿片类药物使用相关的风险因素。
研究设计
回顾性队列研究。
方法
对 2012 年至 2017 年在一家机构接受放疗的 198 名符合条件的口咽癌患者进行了研究。通过病理报告回顾确定 p16/人乳头瘤病毒（HPV）状态。记录阿片类药物的使用情况。进行统计分析以评估慢性阿片类药物使用的风险因素及其对总生存的影响。
结果
平均年龄为 62 岁，平均随访时间为 38 个月。83%的患者患有 III/IV 期疾病，73%的患者接受了放化疗。69%的患者 HPV/p16 阳性。57 名（29%）患者有预先存在的慢性疼痛疾病。53%的患者使用了慢性阿片类药物。年龄≤62 岁（P<0.0001）、有抑郁病史（P=0.0356）、p16 阴性状态（P=0.0097）、治疗前就诊时使用阿片类药物（P=0.0021）以及诊断时存在预先存在的慢性疼痛疾病（P=0.0181）与单因素分析中的慢性阿片类药物使用相关。多因素分析显示，T 分期和焦虑/抑郁与慢性阿片类药物使用相关。使用慢性阿片类药物的患者总体生存率较差，但考虑到复发时无显著差异。
结论
在本队列中，接受口咽鳞状细胞癌治疗的患者中有超过 50%的患者在治疗后成为慢性阿片类药物使用者。在治疗前识别出最有可能使用慢性阿片类药物的患者，可能有助于该患者人群的长期疼痛管理。
证据水平
4 Laryngoscope, 129:2087-2093, 2019.
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