Predictors of persistent opioid use following curative-intent radiation for head and neck cancer.

e18099 Background: Head and neck cancer (HNC) patients often experience pain from intense radiation treatment. Opioids work well to minimize this side effect. However, persistent use during and after treatment can cause significant health problems. There is little data in the literature that can help predict a predisposition for prolonged opioid use in HNC patients who receive radiation. Analysis of such data could aid HNC providers and patients in making appropriate and informed pain management choices. Methods: This study reviewed a retrospective single-institution cohort of HNC patients treated with definitive radiation, chemoradiation, or induction chemotherapy followed by chemoradiation between October 2011 and December 2023. Multivariable logistic regression was used to identify factors associated with continued opioid use at three and six months following radiation. Fine-Gray competing-risk regression evaluated time to first opioid use among opioid-naïve patients. Results: Among 789 patients (81% male; median age 61 years), 95.1% received opioids within 6 months of diagnosis. 40% of these patients continued opioid use three months after treatment and 15% continued use six months following treatment. Patients who continued opioid user at three months post treatment did so independently of other factors that were evaluated such as former smoking, radiation treatment alone, prior opioid use, and palliative medicine involvement. Continued use after six months was associated with opioid use at three months and palliative medicine involvement. Thin weight status and palliative medicine involvement was associated with earlier opioid initiation, while treatments of induction chemotherapy and radiation alone were associated with delayed opioid initiation. Interestingly, patients with advanced disease when care began, had lower long-term opioid risk. Conclusions: When HNC patients get curative radiation treatment, long-term opioid use is common. Early identification of high-risk patients may facilitate targeted opioid treatment strategies that help with pain management while also reducing long-term opioid dependence.