Ganju Rohit, Neeranjun Rishi, Morse Ryan, Lominska Christopher, TenNapel Mindi, Chen Allen M
University of Kansas School of Medicine, Kansas City, KS.
Irvine Chao Family Comprehensive Cancer Center, University of California, Irvine, CA.
Am J Clin Oncol. 2022 Apr 1;45(4):161-167. doi: 10.1097/COC.0000000000000896.
We sought to characterize the incidence of chronic opioid dependence among head and neck cancer survivors treated by radiation, as well as to identify patient and treatment factors associated with persistent use.
The medical records of patients with head and neck cancer who received radiation therapy from January 2012 to July 2016 were reviewed. All patients received 60 to 70 Gy with curative intent. Patients who progressed or died within 1 year were intentionally excluded. Opioid doses were calculated in morphine equivalent daily doses in milligrams (mg). Univariate and multivariate regression models were used to identify associations between demographic, medical, disease, and persistent opioid use.
Two hundred and sixty-one patients were included. The median follow-up was 39 months (range: 12 to 83 mo). Two hundred and eleven patients (80%) received opioids for pain control during radiation. The median morphine equivalent daily dose during treatment was 73.8 mg (range: 5 to 561 mg). Rates of persistent opioid use at 6 months, 1 year, and 2 years from completion of radiation were 41.8%, 30.1%, and 26.0%, respectively. On multivariate analysis, only preradiation opioid use correlated with persistent opioid use at all 3 time points (P<0.05). Smoking history and a Charlson comorbidity index ≥2 predicted for persistent opioid use at some time points, but not all.
High rates of persistent opioid use exist in patients with head and neck cancer after radiation therapy. Early interventions to appropriately wean patients should be further investigated.
我们试图描述接受放射治疗的头颈癌幸存者中慢性阿片类药物依赖的发生率，并确定与持续使用相关的患者和治疗因素。
回顾了2012年1月至2016年7月接受放射治疗的头颈癌患者的病历。所有患者均接受60至70 Gy的根治性放疗。有意排除在1年内病情进展或死亡的患者。阿片类药物剂量以毫克（mg）为单位的吗啡等效日剂量计算。采用单因素和多因素回归模型来确定人口统计学、医学、疾病和持续使用阿片类药物之间的关联。
纳入261例患者。中位随访时间为39个月（范围：12至83个月）。211例患者（80%）在放疗期间接受阿片类药物以控制疼痛。治疗期间的中位吗啡等效日剂量为73.8 mg（范围：5至561 mg）。放疗结束后6个月、1年和2年的持续阿片类药物使用率分别为41.8%、30.1%和26.0%。多因素分析显示，只有放疗前使用阿片类药物与所有3个时间点的持续阿片类药物使用相关（P<0.05）。吸烟史和Charlson合并症指数≥2在某些时间点可预测持续阿片类药物使用，但并非全部。
头颈癌患者放疗后存在较高的持续阿片类药物使用率。应进一步研究早期适当使患者戒断的干预措施。
