Dados do Trabalho

Título

UNVEILING THE PROFILE OF CERVICAL CANCER PATIENTS ON CHRONIC OPIOID USE AFTER RADIOTHERAPY IN A BRAZILIAN CANCER CENTER

Introdução

Cervical cancer (CC) still stands out as one of the main causes of cancer-specific mortality in Brazil. Treatment of locally advanced (LA) disease include external radiotherapy with or without chemotherapy, followed by brachytherapy. Such multimodal approach may have negative impact on quality of life owing to painful long-term complications and chronic pain, often underreported. As a result, high exposure to opioid agents is observed and the risk of misuse or dependence in this population must be assessed.

Objetivo

Describe the characteristics of women with CC using opioids in long-term, to evaluate management of cancer pain and explore risk factors for opioid dependence.

Método

This is a single institution retrospective cohort study. Women diagnosed with LACC between 2014 and 2015 and that had complete response after treatment were identified. Exclusion criteria comprises disease recurrence or death before 6 months, second primary tumor, or previous opioid use. Sociodemographic and clinical data were retrospectively extracted from medical records. Patients with persistent opioid use 6 months after finishing radiotherapy were classified as nonstoppers. Outcomes were analyzed using χ2 or Fisher's exact test, and crude Odds Ratio (OR) was calculated by the Cox proportional hazards.

Resultado

A total of 214 patients were included. Most patients were non-white (64.5%), nonsmokers (55.1%) and never consumed alcohol (60.3%). Clinical data showed that performance status 0 (23.4%) or 1 (70.1%), cancer stage II (43.9%) or III (40.2%) and squamous cell carcinoma (82.7%) were most prevalent; 65% (139) of the cases kept opioids 6 months after finishing radiotherapy. The use of both strong and weak opioids was the only factor associated with persistent opioid use (p<0.001). Other previously known risk factors for opioid misuse were not associated with persistent opioid consumption in this study.

Conclusão

Long-term opioid use to control pain was observed in a great proportion of patients. Gynecologic oncology patients show special risk for opioid misuse due to high chronic pain rates. Careful pain assessment is necessary to avoid inadequate pain control, and early non-opioid strategies such as use of non-opioid medications and multimodality approaches should be applied to reduce strong opioid needs and provide sooner opioid independence.

Palavras-chave

cervical cancer, radiotherapy, opioids

Área

Oncologia - Tumores Ginecológicos