Most head and neck cancer patients were still on opioids three months after radiotherapy

Design

Single-institution retrospective cohort

Population

789 patients with non-metastatic head and neck cancer after definitive radiotherapy or chemoradiotherapy

Primary outcome

Opioid use 3 months after completing radiotherapy

Effect

70.0% at 3 months and 47.3% at 6 months; prior opioid use aOR 2.57 (95% CI 1.82 to 3.63)

A single-institution cohort study of 789 patients with non-metastatic head and neck cancer who had definitive radiotherapy or chemoradiotherapy between 2011 and 2023, median follow-up 46.7 months, examined opioid use after treatment.

Between diagnosis and 6 months after radiotherapy, 750 patients (95.1%) received prescription opioids. At 3 months 552 (70.0%) were still taking them and at 6 months 373 (47.3%). Use at 3 months was more likely with prior opioid use (adjusted OR 2.57, 95% CI 1.82 to 3.63), former smoking (1.55, 1.04 to 2.31) and palliative care referral (3.90, 2.57 to 6.09). Among 296 opioid-naive patients, 57.8% and 37.8% were still on opioids at 3 and 6 months; underweight status was linked to earlier first use (adjusted HR 7.36, 3.40 to 15.90).

This is one American centre, and the data show prescriptions, not misuse or dependency. They do show that stopping is not automatic after treatment ends. The authors suggest stewardship programmes that weigh analgesia against dependency risk.

• Review opioid prescriptions at each follow-up visit after radiotherapy, not only at the start.
• Prior opioid use, former smoking and palliative referral flagged patients still on opioids at 3 months.
• Even opioid-naive patients commonly continued: about 58% at 3 months.
• Set a plan for tapering or handover, and name who owns the prescription.

Why it matters

It shows that opioid prescribing around head and neck radiotherapy rarely ends when treatment does.

Don't overread it

Single-centre prescription data; continued use is not the same as dependency or misuse.

The statistics, in plain English

An adjusted odds ratio of 3.90 means palliative care referral was linked to nearly four times the odds of still taking opioids, after accounting for the other factors in the model. Referral probably marks patients with more pain, so the association is not a cause.

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