Abstract A19: Opioid prescriptions in the military defense system head and neck cancer population, FY2007 - FY2014
Authors: Ambrosio Art A. , Jeffery Diana D. , Hopkins Laura A. , Spevak Christopher J. , Burke Harry B. 
Published: September 2020

Abstract
Purpose: Head and neck cancer (HNC) pain involves nocioceptive and neuropathic inputs from both disease and treatment into a highly innervated area of the body. Hence, opioids are assumed to be used in the pain management of HNC patients. Here, we examine the rates and correlates of opioids prescribed to HNC patients who are beneficiaries of the U.S. Military Health System (MHS).
Methods: We used MHS outpatient, inpatient, and pharmacy claims data, fiscal years (FY) 2007-2014, to ascertain beneficiaries with a primary ICD-9 diagnosis of HNC. Descriptive statistics were used to characterize the population with respect to sociodemographic characteristics, location and source of care, comorbid conditions, and number of filled opioid prescriptions. Analysis of variance and multiple regression were used to identify trends and predictors of the number of opioid agonist prescription(s) per year.
Results: On average per year, 2,944 nonelderly MHS beneficiaries with a primary diagnosis of HNC submitted claims to TRICARE. Most were age 55-64, male, lived in southeast U.S., and received health care in civilian settings only. On average, 0.7% and 12.2% had a concurrent diagnosis indicative of a drug use disorder or alcohol use disorder, respectively, and 26.1% had a documented history of tobacco use. About 44% had head and neck surgery, 84% received radiation therapy, 43% received chemotherapy, and 15% accessed hospice care. On average, 57% of HNC patients received at least 1 opioid agonist prescription per year; this rate was stable over the 8 years of observation. Annual average number of opioid agonist prescriptions per patient ranged from 6.27 (fiscal years 2010 and 2013) to 6.73 (fiscal year 2012). Based on regression analysis, the strongest predictors (p &lt; 0.001) of the number of opioid prescriptions were: hospice use (99% CI 2.236, 2.856), anxiety (99% CI 2.298, 3.063), drug use disorder (99% CI 7.351, 9.992), depression (99% CI 1.692. 2.363), head and neck surgery (99% CI 0.993, 1.434), chemotherapy, tobacco use, number of physical comorbidities, age, and adjustment disorder.
Discussion: The results indicate that the average HNC patient treated in the community receives 6 opioid prescriptions per year. This amount, known to increase risk for prolonged opioid use, is largely related to end-of-life care and mental health and drug use disorders. HNC surgery, while significant, was not as strong a predictor. While high opioid use is expected in end-of-life care, the results suggest that all HNC patients need to be regularly screened for mental health comorbidities, particularly drug use disorders. We recommend that oncologists and primary care providers of HNC patients follow guidelines and develop management plans specific to opioid prescribing such as those found in the Veterans Administration/Department of Defense Clinical Practice Guidelines for Opioid Therapy for Chronic Pain, v. 3.0.
Citation Format: Art A. Ambrosio, Diana D. Jeffery, Laura A. Hopkins, Christopher J. Spevak, Harry B. Burke. Opioid prescriptions in the military defense system head and neck cancer population, FY2007 - FY2014 [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A19.