2797 - An Analysis of Acute-on-Chronic Pain and Opioid Dependency In a Prospective Head and Neck Cancer Cohort Treated with Radiation Therapy
Presenter(s)
M. Mahin1, O. Nkuku1, R. He1, C. D. Fuller2, A. C. Moreno3, and S. Javed4; 1The Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4The Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Acute pain is a debilitating condition that is commonly experienced by patients with head and neck cancers (HNC) undergoing radiation therapy (RT). Non-standardized opioid use is often prescribed, and these patients remain at high risk of developing chronic pain syndromes and opioid persistence. We have previously characterized acute pain profiles and their association with worsening physiologic kinetics, including weight loss. The objectives of this study were to evaluate temporal pain profiles from the subacute-to-chronic phases of early surveillance and to identify independent predictors of opioid dependency.
Materials/Methods: HNC patients treated with standard fractionation (6-7 weeks) RT from 02/2021 to 06/2024 were eligible for inclusion. Patients who submitted electronic patient-reported pain scores for at least 4 on-treatment visits (first, last, and 2 in between) and an early (6–15 weeks, FUP1) or late follow-up (21–30 weeks, FUP2) visit were included. Pain area under the curve (AUC) values were calculated for respective acute (during RT, AUCpain-acute), subacute (AUCpain-subacute for FUP1), and chronic (AUCpain-chronic for FUP2) post-therapy assessments. Penalized logistic regression models were developed to identify independent predictors of persistent opioid use.
Results: Among 1,118 eligible head and neck cancer (HNC) patients, 397 (35.5%) and 106 (9.4%) patients had evaluable pain data during FUP1 and FUP2, respectively. For FUP1, the median age was 62 years, with 77% male, 90% white, and 44% current or former smokers. The predominant diagnoses included oropharyngeal and oral cavity cancers (41%). Nearly half received concurrent chemoradiation with or without induction therapy (48%), 12% underwent RT alone, and 42% underwent surgery before RT. Mean AUCpain-acute, AUCpain-subacute, and AUCpain-chronic scores were 0.20 0.24 and 0.23, respectively. For both follow-up periods, AUCpain-acute was a significant predictor of persistent opioid use with a 0.01 unit increase in AUCpain-acute correlating to a 5% and 3% increase in odds of opioid use during FUP1 and FUP2, respectively. At FUP1, a current/former smoking history nearly doubled the odds of opioid use (P=0.01), while being of Asian race (vs. White) and having a larynx/hypopharynx primary (vs. oropharynx) were protective predictors (P<=0.05). At FUP2, age >= 60 was an additional predictor of chronic opioid use, while gender, race, smoking history, primary tumor site, treatment category, and use of benzodiazepines had a non-significant impact.
Conclusion: Pain AUC profiles can be leveraged to summarize longitudinal pain burden in HNC patients treated with RT. We demonstrated that AUCpain-acute is the primary driver of subacute and chronic opioid persistence. These findings support the need to risk-stratify patients for AUCpain-acute-driven pain management pathways immediately following RT completion in patients at high risk of developing subacute-on-chronic opioid dependency.