Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA.
Riverdale Country School, Riverdale, Bronx, NY, USA.
Oral Oncol. 2019 May;92:1-5. doi: 10.1016/j.oraloncology.2019.03.007. Epub 2019 Mar 12.
Patients undergoing radiation treatment (RT) for head and neck malignancies often suffer significant disease- and treatment-related pain requiring opioids for effective management. However, the prevalence and associated risk factors of prolonged opioid use in this population remain poorly characterized. We sought to quantify the rate of prolonged opioid use among opioid naïve patients receiving curative-intent RT for head and neck malignancies and to identify associated risk factors.
We retrospectively identified patients who had undergone RT for head and neck malignancies at our institution between Jan 2011 and Sept 2017. Our primary endpoint was persistent opioid use 6-months following completion of RT. Patients were included if they were opioid-naïve, underwent curative intent RT, had adequate follow-up, and did not have residual or recurrent disease within our follow-up period. Univariable and multivariable logistic regression was utilized to identify risk factors for prolonged opioid use.
We identified 311 patients meeting our inclusion criteria; 40 (12.9%) continued to use opioids 6-months following RT. Univariable analysis found current smoking, alcohol abuse, RT dose, treatment to the bilateral necks, induction chemotherapy, concurrent chemotherapy, PEG tube, daily milligram morphine equivalents, and adjuvant analgesic medication use to be positively associated with prolonged opioid use; prior surgery was negatively associated with prolonged opioid use. Delivery of induction chemotherapy (OR 2.86, CI (95%) 1.32-6.21) and alcohol abuse (OR 3.75, CI (95%) 1.66-8.47) remained statistically significant on multivariable analysis.
The prevalence of prolonged opioid use in previously opioid naïve patients undergoing curative intent head and neck RT was just under 13%. Patients with history of alcohol abuse and those who undergo induction chemotherapy were most at risk.
接受头颈部恶性肿瘤放射治疗（RT）的患者常因疾病和治疗相关的疼痛而需要使用阿片类药物进行有效管理。然而，该人群中阿片类药物长期使用的流行率及其相关危险因素仍描述不足。我们旨在定量评估初治头颈部恶性肿瘤接受根治性 RT 治疗的阿片类药物初治患者中延长使用阿片类药物的发生率，并确定相关的危险因素。
我们回顾性地确定了 2011 年 1 月至 2017 年 9 月在我院接受头颈部恶性肿瘤 RT 的患者。我们的主要终点是在 RT 完成后 6 个月持续使用阿片类药物。如果患者为阿片类药物初治、接受根治性 RT、有足够的随访且在随访期间无残留或复发性疾病，则将其纳入研究。我们使用单变量和多变量逻辑回归来确定延长阿片类药物使用的危险因素。
我们确定了 311 名符合纳入标准的患者；40 名（12.9%）在 RT 后 6 个月仍继续使用阿片类药物。单变量分析发现，当前吸烟、酒精滥用、RT 剂量、双侧颈部治疗、诱导化疗、同期化疗、PEG 管、每日吗啡等效剂量和辅助镇痛药物的使用与延长阿片类药物使用呈正相关；而既往手术与延长阿片类药物使用呈负相关。多变量分析显示，接受诱导化疗（OR 2.86，CI（95%）1.32-6.21）和酒精滥用（OR 3.75，CI（95%）1.66-8.47）仍具有统计学意义。
初治头颈部 RT 治疗的阿片类药物初治患者中，延长使用阿片类药物的流行率接近 13%。有酒精滥用史和接受诱导化疗的患者风险最高。
