Long-term Opioid Therapy, Depression and Suicide Mortality Risk in Patients with Head and Neck Cancer

头颈癌患者的长期阿片类药物治疗、抑郁和自杀死亡风险

• 批准号: 10597344
• 负责人: Nosayaba Osazuwa-Peters
• 金额: $ 44.8万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10597344
• 关键词: Acute Pain; Adult; Anxiety; Benchmarking; Cancer Burden; Cancer Pain Management; Cancer Survivor; Caring; Clinical; Complex; Data; Depression and Suicide; Depression screen; Development; Dose; Dose-Rate; Frequencies; Fright; Future; Goals; Head and Neck Cancer; Helping to End Addiction Long-term; Human; Intervention; Investigation; Lead; Link; Literature; Long-Term Effects; Malignant Neoplasms; Medical Records; Medicare; Mental Depression; Morphine; Oncology; Opioid; Pain; Pain management; Patients; Persons; Population; Race; Recording of previous events; Research; Risk; Risk Factors; Role; Severities; Substance Use Disorder; Symptoms; Testing; United States Department of Veterans Affairs; United States National Institutes of Health; active method; advanced analytics; base; biological sex; cancer care; cancer pain; cancer site; cancer therapy; chronic pain; chronic pain management; clinical care; cohort; depressive symptoms; head and neck cancer patient; milligram; misuse of prescription only drugs; mortality risk; non-cancer pain; novel; opioid epidemic; opioid mortality; opioid therapy; opioid use; patient population; prescription opioid; prescription opioid misuse; psychosocial; public health relevance; response; secondary analysis; standard care; suicidal risk; suicide mortality; suicide rate

PROJECT SUMMARY/ABSTRACT The proposed project is in response to RFA-DE-22-011: HEAL Initiative: Secondary Analysis and Integration of Existing Data Related to Acute and Chronic Pain Development or Management in Humans. The HEAL Initiative is a trans-NIH project, Helping to End Addiction Long-term, was launched in 2018 as a direct response to the opioid crisis in the US. This crisis is even more complex in oncology as pain is one of the most feared symptom among cancer survivors, and opioid use is central to pain management in cancer care. While cancer survivors have a significantly increased risk of long-term use of opioid, in head and neck cancer (HNC), over 80% of patients have a history of receipt of opioid prescription during care, and up to 15% of patients continue using opioids long after active treatment, increasing their risk of long-term opioid therapy (LTOT), which is >90 days of opioid use following treatment. The need to characterize opioid use in HNC is underscored by the fact that HNC which only accounts for 3% of the total US cancer burden, might be responsible for 12% of opioid-related deaths among patients with cancer. Risk of both depression and suicide are higher among patients with HNC compared with the general US population; however, the relative contribution of long-term opioid treatment to these adverse psychosocial consequences of HNC is unknown. About 1-in-2 patients with HNC have a lifetime history of depression, which is significantly associated with chronic pain. In addition, HNC has the second highest rate of suicide of all cancer sites, also associated with chronic pain. It is unknown if LTOT is associated with risk of depression in these patients, or whether it increases risk of suicide in HNC. It is therefore critical to understand to establish the relative contribution of LTOT to adverse psychiatric sequelae in patients with HNC. Long-term, we hope to decrease depression and suicide risks in cancer, and develop and implement tailored interventions that will inform safe opioid prescribing, and provide evidence leading to alternative pain management in HNC and oncology care in general. Our long-term goals align with both the HEAL initiative, and several Healthy People 2030 objectives, such as reducing the proportion of adults who misuse prescription opioids, as well as decreasing suicide rate in the US by 25% in the next decade. However, to achieve these long-term goals, it is necessary to first quantify the role of LTOT in depression and suicide risks among patients with HNC beyond establishing correlations or associations. Using two distinct, independent large cohorts of patients with HNC, the objective of this proposed project is to establish the role of LTOT in depression and suicide among patients with HNC, using advanced analytics that allows for establishing temporality, dose-response and other causal-related inferences in observational data. Findings from this proposed research will impact clinical care in oncology related to safer opioid prescribing, and alternative pain management, which would decrease risk of depression and suicide in the HNC patient population.

项目摘要/摘要 拟议的项目是对RFA-DE-22-011的回应：Heal Initiative：次要分析和整合 现有数据与人类的急性和慢性疼痛发展或管理有关。治愈 Initiative是一个Trans-NIH项目，有助于长期结束成瘾，于2018年发起了直接 对美国阿片类药物危机的反应。由于疼痛是最大的危机，这场危机更加复杂 癌症幸存者中担心的症状，阿片类药物的使用对于癌症护理中的疼痛管理至关重要。尽管 癌症幸存者在头颈癌（HNC）中长期使用阿片类药物的风险显着增加 超过80％的患者在护理过程中有接受阿片类药物处方的病史，多达15％的患者 积极治疗后很长时间继续使用阿片类药物，增加其长期阿片类药物治疗的风险（LTOT）， 治疗后使用> 90天的阿片类药物使用。需要表征HNC中阿片类药物使用的需求是 对仅占美国总癌症负担的3％的HNC的事实强调了 负责癌症患者中12％的阿片类药物相关死亡。抑郁和自杀的风险 与美国普通人群相比，HNC患者的患者更高；但是，亲戚 长期阿片类药物治疗对HNC的这些不良社会心理后果的贡献尚不清楚。 大约1英寸HNC患者具有抑郁症的寿命，这与 慢性疼痛。此外，HNC的自杀率是所有癌症部位的第二高率，也与 慢性疼痛。未知LTOT是否与这些患者的抑郁症风险有关，或者是否与 增加了HNC自杀的风险。因此，要了解建立相对贡献是至关重要的 HNC患者的LTOT对精神病性后遗症不良。长期，我们希望减少抑郁症和 癌症中的自杀风险，并制定和实施量身定制的干预措施，这些干预措施将为安全阿片类药物提供信息 开处方，并提供证据，导致HNC和肿瘤护理中的替代性疼痛管理 一般的。我们的长期目标既符合医疗计划 例如减少滥用处方阿片类药物的成年人的比例，并降低自杀率 在未来十年中，在美国将达到25％。但是，要实现这些长期目标，有必要首先 量化LTOT在HNC患者中的抑郁症和自杀风险中的作用以外 相关或关联。使用两个独立的大型HNC患者，目的 这项拟议的项目是在HNC患者中确定LTOT在抑郁和自杀中的作用， 使用允许建立时间性，剂量反应和其他因果关系相关的高级分析。 观察数据中的推论。这项拟议研究的发现将影响肿瘤学的临床护理 与更安全的阿片类药物处方和替代性疼痛管理有关，这将降低抑郁症的风险 和HNC患者人群的自杀。