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Science in the News

A Recent Study Attempted to Identify Prevalence of and Factors Associated with Chronic Opioid Use Following Surgery to Treat Oral Cavity Carcinoma

April 28, 2017 A small, retrospective cohort study1 conducted in a consecutive series of adult patients undergoing surgery for oral cavity cancer at a single academic center attempted to assess the prevalence of chronic opioid use in this population; to evaluate possible associated clinical factors with development of chronic opioid use; and to characterize any association between opioid use and survival.  Ninety-nine consecutive adults (age 18 years or older) with confirmed carcinoma of the oral cavity who were surgically treated from January 1, 2011 to September 30, 2016 were identified through the institutional cancer registry.  The main evaluated study outcome was chronic opioid use, defined as an individual having received multiple opioid prescriptions more than 90 days after surgery as evidenced by recurring prescriptions in the electronic medical record or in the institutions Controlled Substance Utilization Review and Evaluation System (CURES). Factors associated with chronic opioid use were investigated by univariable and multivariable logistic regression. The Kaplan-Meier method and Cox proportional hazards model were used to assess overall survival (OS) and disease-free survival (DFS). Sixty percent of the population was male and the mean (SD) age was 62.6 (14.3) years. Twenty-five patients (25%) had a prior psychiatric disorder, and 40 patients (40%) were taking an opioid prior to surgery. History of alcohol use was observed in 34 patients (34%), and prior tobacco use was observed in 65 patients (66%).

Chronic opioid use following surgery was seen in 41 patients (41%). On multivariable logistic regression, preoperative opioid use (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.2 to 14.3), tobacco use (OR, 2.8; 95% CI, 1.0 to 8.0), and disease persistence, recurrence, or development of a second primary tumor (OR, 2.8; 95% CI, 1.0 to 7.4) were associated with chronic opioid use. Among preoperative opioid users, estimated overall survival (hazard ratio [HR], 3.2; 95% CI, 1.4 to 7.1) was decreased, and chronic opioid use was associated with decreased disease-free survival (HR, 2.7; 95% CI, 1.1 to 6.6).  The authors noted that the prevalence of chronic opioid use in this study was higher than that reported across other surgical sites and populations.

The authors acknowledged several study limitations;1 the relatively small sample size was judged to be the primary limitation, precluding “more precise determination of factors associated with chronic opioid use and to more soundly assess the association between opioid use and survival.” Inability to account for nonelectronic (i.e., handwritten) prescriptions or to capture prescriptions written from within federal health systems (i.e., Veterans Affairs, military hospitals) may have led to an underestimate of the true prevalence of chronic opioid use. Finally, the observed associations between chronic opioid use and DFS and OS may be unreliable, as chronic opioid use was also associated with recurrent or persistent disease.

References

  1. Pang J, Tringale KR, Tapia VJ, et al. Chronic opioid use following surgery for oral cavity cancer. JAMA Otolaryngology-Head & Neck Surgery 2017.

Prepared by: Center for Scientific Information, ADA Science Institute


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