Long-Term Opioid Use After Treatment of Head and Neck Cancers: A Systematic Review and Meta-analysis

Objective: We determined the rates of long-term opioid use in head and neck cancer patients to better understand what characteristics increase the odds of long-term opioid use in these patients. Data Sources: Cochrane Central, EMBASE, MEDLINE, PsycINFO, CINHAL, PubMed, and the gray literature were searched from July 2004 to July 2024. Review Methods: We included meta-analyses examining the relationship between head and neck cancers and long-term opioid use. We calculated pooled rates and compared factors using confidence intervals, chi square, and odds ratios. Results: Of 90 articles retrieved, 12 were included for meta-analysis for a total of 2839 patients. The overall rates of opioid use were 44% at 3 months and 27% at 6 months. At both 3 and 6 months, higher T stage, pretreatment opioid use, alcohol use, tobacco use, psychological illness, history of chronic pain, and gastrostomy tube use were associated with higher rates of opioid use. Additionally, lymph node metastasis and lack of gabapentin use were also associated with use only at 3 months, whereas unmarried status was only associated with use at 6 months. Overall, laryngeal and oropharyngeal primaries had higher rates of use than oral cavity, and chemotherapy or radiation treatment also led to higher rates of use. Conclusion: Head and neck cancer patients have one of the highest rates of long-term opioid use, with various demographic, oncologic, and medical factors associated with higher rates.