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With the advances in the management of head and neck cancer (HNC), patients tend to survive longer after their diagnosis. These people face the burden of chronic pain management which is strongly associated with HNC. A HNC team in Portland USA looked at over 5000 patients from the Veterans Health Administration (VA) treated for cancers of the upper aerodigestive tract over a seven-year period. The aim of the study was to assess their opioids requirements at two-year follow-up and identify factors associated with long-term opioid use post HNC diagnosis. The authors found that about 8% of these patients were prescribed at least a moderate dose of opioids two years post cancer diagnosis. A more advanced cancer stage, pre-cancer substance use disorders or opioid prescriptions were associated with increased risk for long-term opioid use. As expected, rates of narcotic use disorders were higher among patients prescribed higher doses of opioids. This study therefore demonstrated that HNC survivors are at increased risk of long-term opioid requirements. Therefore, consideration of non-opioid pain relief such as gabapentin or nonsteroidal anti-inflammatory at the end of the treatment is paramount. Also, a careful assessment of opioid use disorder risk factors should be completed prior to commencing treatment of HNC. The main limitation that makes generalisation of the study findings complicated was that the participants were suffering from I–IVb HNC without a recurrence, and had survived two years after their initial diagnosis. Therefore, results may not generalise to those with more advanced or recurrent HNC.

Prevalence and correlates of high-dose opioid use among survivors of head and neck cancer.
Nugent SM, Slatore CG, Winchell K, et al.
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Timoleon Siempis

Belfast Health and Social Care Trust, Belfast. UK.

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