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Background: Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time. Methods: Using linked Surveillance, Epidemiology, and End Results–Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I–III HNC and who had ≥6 months of treatment‐free follow‐up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow‐up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty. Results: Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1‐year follow‐up). PCPs prescribed 47% of all fills (42%–55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP. Conclusions: PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population. Half of older head and neck cancer (HNC) survivors, who experience a high burden of pain after treatment completion, fill opioid prescriptions in the early years after treatment completion, and those who fill opioid prescriptions are most likely to have their opioids prescribed by a primary care provider. Further exploration of opioid safety among HNC survivors, and interventions to improve opioid safety, should focus largely on primary care settings in the early years after treatment completion. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors receive more long‐term opioid therapy (LTOT) than people without cancer, but the safety of LTOT prescribing is unknown. Methods: Opioid‐naive adults aged ≥66 years who had been diagnosed in 2008‐2015 with breast, lung, head and neck, or colorectal cancer were identified with data from Surveillance, Epidemiology, and End Results cancer registries linked with Medicare claims. Survivors with 1 or more LTOT episodes (≥90 consecutive days) occurring ≥1 year after their cancer diagnosis and before censoring at hospice entry, another cancer diagnosis, 6 months before death, or December 2016 were included. The safety of prescribing during the first 90 days of the first LTOT episode was measured during follow‐up. As a positive safety indicator, the proportion of survivors with concurrent nonopioid pain management was measured. Indicators of less safe prescribing were the proportion of survivors with a high average daily opioid dose (≥90 morphine milligram equivalents) and the proportion of survivors with concurrent benzodiazepine dispensing. Multivariable logistic regression analyses were conducted to identify clinical predictors of each safety outcome. Results: In all, 3628 cancer survivors received LTOT during follow‐up (median duration, 4.9 months; interquartile range, 3.5‐8.0 months). Seventy‐two percent of the survivors received multimodal pain management concurrently with LTOT. Eight percent of the survivors had high‐dose opioid prescriptions; 25% of the survivors received benzodiazepines during LTOT. Multivariable analyses identified variations in safety measures by multiple clinical factors, although none were consistently significant across outcomes. Conclusions: To improve safe LTOT prescribing for survivors, efforts should focus on increasing multimodal pain management and reducing inappropriate benzodiazepine prescribing. Different clinical predictors of each outcome suggest different drivers of safe prescribing. Cancer survivors are more likely than those without cancer to receive long‐term opioid therapy, and this study of older survivors of cancer finds shortcomings in the safety of long‐term opioid therapy prescribing. Specifically, 28% of survivors receive opioids without concurrent multimodal pain management, 8% of survivors have high average daily opioid doses, and 25% of survivors receive concurrent opioids and benzodiazepines. [ABSTRACT FROM AUTHOR]

Background: Survivors of head and neck cancer (HNC) have increased risk of opioid misuse. Methods: Using Surveillance, Epidemiology and End‐Results‐Medicare data, we matched adults ≥66 years diagnosed with HNC 2008‐2015 with cancer‐free controls. We computed odds ratios (OR) for receipt of chronic opioid therapy (COT, claims for ≥90 consecutive days) for HNC survivors compared to controls each year after matching through 2016. Results: The cohort of HNC survivors declined from 5107 in the first year after diagnosis to 604 in the sixth year after diagnosis. For 5 years, rates of COT among HNC survivors exceeded that of controls. Differences between survivors and controls declined each year (ORs: year 1, 4.36; year 2, 2.60; year 3, 2.18; year 4, 1.85; and year 5, 1.35; all P‐values <.05). Conclusions: Among older HNC survivors, cancer‐associated opioid use in the first years after diagnosis suggests that the benefit of opioids must balance the risk of opioid misuse. [ABSTRACT FROM AUTHOR]

Background: Low body mass index (BMI) is suspected of being associated with low transdermal fentanyl (TDF) blood levels and worse pain relief. Clinical pain data to support this claim are lacking. Methods: Using a Chronic Pain Registry, we identified 901 cancer patients who received TDF at outpatient pain service clinics of our cancer center from 7/1/2011 to 12/1/2016. Of these, 240 patients had a BMI measure, pain intensity, and pain relief scores documented within 30 days of a TDF order. We examined associations between BMI, TDF dose, Worst and Least pain scores, and pain relief scores using standard statistical tests. Results: In cancer patients receiving TDF, low BMI (<18.5) was significantly associated with greater pain relief irrespective of TDF dose and borderline significantly associated with greater percent pain relief after controlling for age, cancer diagnoses, and pain etiology (P =.073), suggesting that low BMI may independently predict better pain relief in cancer patients. As there were no significant associations between BMI and TDF dose, we find no basis for BMI‐dependent dose modification or avoiding TDF in cachectic and low BMI patients. Conclusions: When predicting percent pain relief, we conclude that there is no basis for avoiding TDF or modifying its dose in cancer patients with low BMI and cachexia. [ABSTRACT FROM AUTHOR]