Predictors of Long‐Term Opioid Treatment Among Patients Who Receive Chemoradiation for Head and Neck Cancer

Introduction. The factors associated with successful opioid discontinuation after cancer treatment are not well‐known. We determined the proportion of patients with advanced head and neck cancer who continued using opioids 3 months after the completion of radiation therapy with or without chemotherapy. Methods. We included 70 patients with head and neck cancer referred to our institution's supportive care center between January 1, 2008, and December 31, 2010. Patients who no longer used opioids 3 months after the completion of radiation therapy were classified as stoppers; patients who continued using opioids were considered nonstoppers. We compared demographics, cancer‐related characteristics, alcoholism, substance abuse history, use of psychoactive drugs, and opioid‐related factors between stoppers and nonstoppers. Results. In all, 44 of 70 patients (63%) and 23 of 70 patients (33%) continued opioids 3 months and 6 months after the completion of radiation therapy, respectively. A total of 18 of 44 nonstoppers (41%) and 3 of 26 stoppers (12%) were positive for alcoholism based on the CAGE questionnaire (i.e., Cut down, Annoying, Guilty, Eye opener; odds ratio: 5.3). Demographic and clinical characteristics did not differ between stoppers and nonstoppers. The median duration of any type of opioid use of CAGE‐positive patients was significantly longer than that of CAGE‐negative patients (median: 261 days vs. 93 days; hazard ratio: 2.5). Conclusion. CAGE positivity is a risk factor for opioid use beyond 3 months after the completion of radiation therapy and for duration of opioid treatment. Routine CAGE screening and meticulous follow‐up are needed for these patients. 摘要 引言. 恶性肿瘤治疗后成功停用阿片类药物的相关因素尚不明确。我们确定了头颈癌患者放疗完成（无论是否接受化学治疗）后3个月继续使用阿片类药物的比例。 方法. 纳入了2008年1月1日∼ 2010年12月31日转诊至本机构支持治疗中心的70例头颈癌患者。将放疗完成后3个月不再使用阿片类药物的患者列为停用者；将继续使用阿片类药物的患者列为未停用者。对停用者和未停用者的人口统计学特征、肿瘤相关特征、酗酒、药物滥用史、精神药物的使用以及阿片类药物相关因素进行了比较。 结果. 4 所有患者中，分别有63%（44/70）和33%（23/70）的患者在放射治疗完成后3个月和6个月继续使用阿片类药物。共有41%（18/44）的未停用者和12%（3/26）的停用者根据CAGE问卷[即：自觉应减少饮酒（Cut down）、不快感（Annoying）、愧疚感（Guilty）、晨醒即饮酒（Eye opener）；比值比：5.3]判断为存在酗酒问题。停用者和未停用者之间的人口统计学特征和临床特征均无差异。CAGE阳性患者的中位疗程（无论使用何种阿片类药物）显著长于CAGE阴性患者（中位数：261天vs. 93天；风险比：2.5）。 结论. CAGE阳性是放疗完成后超过3个月仍然使用阿片类药物以及阿片类药物疗程延长的风险因素。这些患者需要接受常规CAGE筛查及细致随访。The Oncologist 2013;18:768–774 This retrospective study aimed to determined the proportion of patients with advanced head and neck cancer who continued to use opioids after the completion of radiation therapy. CAGE positivi