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.

项目总结/摘要 建议的项目是响应RFA-DE-22-011：HEAL倡议：二次分析和整合 与人类急性和慢性疼痛发展或管理相关的现有数据。愈合 倡议是一个跨NIH项目，帮助结束长期成瘾，于2018年作为一个直接的 对美国阿片类药物危机的反应。这一危机在肿瘤学中更为复杂，因为疼痛是最重要的疾病之一。 在癌症幸存者中，阿片类药物的使用是癌症护理中疼痛管理的核心。而 癌症幸存者长期使用阿片类药物的风险显著增加，在头颈癌（HNC）中， 超过80%的患者在护理期间有接受阿片类药物处方的历史，高达15%的患者 在积极治疗后长期继续使用阿片类药物，增加了长期阿片类药物治疗（LTOT）的风险， 这是治疗后使用阿片类药物的>90天。需要描述HNC中阿片类药物使用的特征， HNC仅占美国癌症总负担的3%，这一事实强调了这一点， 癌症患者中12%的阿片类药物相关死亡是由它造成的。抑郁和自杀的风险 HNC患者中的HNC发生率高于一般美国人群;然而， 长期阿片类药物治疗对HNC的这些不良心理社会后果的作用尚不清楚。 大约1/2的HNC患者有抑郁症的终生病史，这与以下因素显著相关： 慢性疼痛此外，HNC在所有癌症部位中自杀率第二高，也与 慢性疼痛目前尚不清楚LTOT是否与这些患者的抑郁风险相关，或者是否与这些患者的抑郁风险相关。 增加HNC的自杀风险。因此，至关重要的是要了解，以确定相对贡献的 LTOT对HNC患者的不良精神后遗症的影响。从长远来看，我们希望减少抑郁症， 癌症的自杀风险，并制定和实施量身定制的干预措施， 开出处方，并提供HNC替代疼痛管理和肿瘤学护理的证据 将军我们的长期目标与HEAL倡议和多个健康人2030目标保持一致， 例如减少滥用处方阿片类药物的成年人比例，以及降低自杀率 在未来十年，美国将增长25%。然而，要实现这些长期目标，首先必须 量化LTOT在HNC患者抑郁和自杀风险中的作用， 相关性或关联性。使用两个不同的、独立的大型HNC患者队列， 该项目的目的是确定LTOT在HNC患者抑郁和自杀中的作用， 使用先进的分析，允许建立时间性，剂量反应和其他与药物相关的 观察数据中的推论。这项拟议研究的结果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疼痛管理有关，这将降低抑郁症的风险 HNC患者人群中的自杀率。