The edition · ENT & Head and Neck Surgery
Seven in ten patients were still taking opioids three months after head and neck radiotherapy
A 789-patient cohort found that opioid use persisted long after treatment, most often in those on opioids beforehand. Also: coffee intake and head and neck cancer by site, cost-effectiveness of perioperative pembrolizumab by PD-L1 score, and no added benefit from pillar suturing in children's sleep apnoea surgery.
The edition in brief
A single-centre cohort of 789 patients with non-metastatic head and neck cancer treated with definitive radiotherapy or chemoradiotherapy found that 95.1% received prescription opioids between diagnosis and 6 months after radiotherapy, and 70.0% and 47.3% were still taking them at 3 and 6 months. Prior opioid use (adjusted OR 2.57), former smoking (1.55) and palliative care referral (3.90) were associated with use at 3 months. A meta-analysis of 30 studies linked three or more cups of coffee a day to lower overall head and neck cancer risk (OR 0.78), lower oral and pharyngeal cancer risk, but higher laryngeal cancer risk (OR 1.13); these are observational associations. A US modelling study found perioperative pembrolizumab cost-effective for PD-L1 CPS above 10 but not for CPS 1 to 10. A meta-analysis of 11 studies found no added benefit of pillar suturing or pharyngoplasty over tonsillectomy in children with obstructive sleep apnoea.
Most head and neck cancer patients were still on opioids three months after radiotherapy
Plan opioid review and tapering from the start of radiotherapy, and revisit it at every follow-up.
Coffee and head and neck cancer: lower risk overall, higher at the larynx, as an association
Do not advise coffee for cancer prevention; keep counselling on tobacco, areca nut and alcohol.
Perioperative pembrolizumab: cost-effective only above a PD-L1 score of 10 in a US model
Make sure PD-L1 CPS is available before discussing perioperative immunotherapy, since value differed by score.
Ask about alcohol, tobacco and areca nut at every head and neck visit
Ask about tobacco, areca nut and alcohol at every visit and offer help in the same consultation.
Pillar suturing and pharyngoplasty added no clear benefit to tonsillectomy in children's sleep apnoea
Consider omitting routine pillar suturing or pharyngoplasty when operating for sleep apnoea in children.
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