High Opioid Use in Patients With Head, Neck Cancer Undergoing Treatment

Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) often use high-dose opioids to manage pain related to an adverse effect of treatment, mucositis, while undergoing and following chemoradiation therapy, according to the results of a recent study presented at the 2023 Hematology/Oncology Pharmacy Association annual conference.

“The majority of [patients with] HNSCC receiving chemoradiation require high doses of opioids for management of mucositis, with nearly half still requiring opioids at 3 months post-treatment,” the researchers wrote of the study results.

The researchers conducted a single-center, retrospective chart review to examine pain and mucositis management in this patient population. A total of 65 adults with HNSCC who received chemoradiation from January 2020 to December 2020 at the University of North Carolina Medical Center were included.

The primary outcome was the morphine milligram equivalent (MME) during weeks 1 to 7 of chemoradiation and up to 3 months following treatment cessation. Time of highest MME, time to first opioid prescription during chemoradiation, addition of long-acting opioids, use of gabapentin and/or pregabalin during treatment, and continued use of opioids at 3 months post-treatment were among the secondary measures.

Of the total patients, 56 were prescribed opioids. Most patients received cisplatin-based chemoradiation (91%) in the definitive setting (92%). Further, the majority of patients had a total radiation dose greater than 60 cGy (78%) and had oropharyngeal cancer (63%). The placement of a feeding tube was required during the treatment course of more than two-thirds of participants.

The results revealed that the average total MME was 3166 for week 1 to 7, 1917 for week 8 to 12, 1246 for week 13 to 16, and 1229.8 for week 16 to 3 months. Following chemoradiation, 43% of these patients required continuation of opioids at 3 months.

Additionally, the results indicated that initiation of short-acting opioids occurred during week 3 and 52% of patients required long-acting opioids. Patients required the largest MME amount during week 5. A total of 10 patients required gabapentin during radiation.

While the analysis of subgroups is still ongoing, the researchers concluded, “Further investigation is warranted to identify non-opioid strategies to optimize the management of mucositis pain secondary to chemoradiation.”

Reference

Kohler L. Characterization of opioid use in patients undergoing chemoradiation therapy in head and neck cancer. Poster presented at: Hematology/Oncology Pharmacy Association annual conference; March 29-April 1, 2023; Phoenix, AZ. Accessed April 4, 2023. https://www.hoparx.org/membership/hopa-annual-conference-2023/