{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:49:09Z","timestamp":1790912949726,"version":"4.1.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Introduction<\/jats:title>\n Head and neck cancer (HNC), one of the most emotionally distressing cancers, carries a significant burden of psychiatric comorbidities. While opioids are commonly prescribed in cancer care, the association between preexisting psychiatric risk factors and prescription opioid use in HNC remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the hypothesis that preexisting psychiatric risk factors are associated with any opioid prescription and long-term opioid therapy in patients with HNC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective longitudinal cohort study used deidentified data from the Optum electronic health record database, comprising a random sample of 5 million patients across the US between January 2010 and December 2018. Eligible patients were adults diagnosed with HNC. Using a 2-year look-back prior to the index date of HNC diagnosis, patients who used prescription opioids prior to HNC diagnosis were excluded. The data analysis was conducted between July 2022 and July 2023.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes of interest were receipt of any prescription opioid within 12 months of index HNC and long-term opioid therapy (LTOT), defined as 10 or more opioid prescriptions within 12 months of index HNC. Psychiatric risk factors included anxiety disorders, depression, smoking\/nicotine dependence, substance use disorders, and benzodiazepine prescription. Multivariate logistic regression estimated the odds of opioid use based on preexisting psychiatric factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 20\u202f286 patients with an HNC diagnosis, 11\u202f335 met all eligibility criteria. Patients in the analytic cohort had a mean (SD) age of 57.1 (15.5) years, and 55.4% were female. Within 12 months of HNC diagnosis, 23.4% received an opioid prescription, and 4.9% received LTOT. In fully adjusted models, depression (adjusted odds ratio [aOR], 1.21; 95% CI, 1.01-1.45), nicotine dependence (aOR, 1.56; 95% CI, 1.40-1.73), and benzodiazepine comedication (aOR, 1.44; 95% CI, 1.22-1.70) were associated with increased odds of receiving any opioid prescription. Furthermore, male patients had 49% greater odds of receiving opioid prescriptions (aOR, 1.49; 95% CI, 1.36-1.64). Only smoking\/nicotine dependence was associated with increased odds of LTOT (aOR, 1.77; 95% CI, 1.21-2.61).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Preexisting psychiatric comorbidities, especially depression and smoking\/nicotine dependence, were associated with increased odds of prescription opioid use and LTOT in patients with HNC in this longitudinal cohort study. Screening for these comorbidities during the management of patients with HNC can be impactful in informing clinical decisions that contribute to safer opioid prescribing.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.2649","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T15:31:36Z","timestamp":1756999896000},"page":"1166","source":"Crossref","is-referenced-by-count":2,"title":["Preexisting Psychiatric Risk Factors and Any and Long-Term Opioid Use in Head and Neck Cancer"],"prefix":"10.1001","volume":"151","author":[{"given":"Nosayaba","family":"Osazuwa-Peters","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Duke Cancer Institute, Durham, North Carolina"},{"name":"Center for the Study of Suicide Prevention and Intervention, Duke University School of Medicine, Durham, North Carolina"},{"name":"Deputy Editor, JAMA Otolaryngology\u2013Head & Neck Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May Z.","family":"Gao","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russel R.","family":"Kahmke","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Duke Cancer Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya P.","family":"Ramkumar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of Arizona College of Medicine, Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle"},{"name":"Department of Psychosocial Oncology, Fred Hutchinson Cancer Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey F.","family":"Scherrer","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, St Louis University School of Medicine, St Louis, Missouri"},{"name":"Advanced HEAlth Data (AHEAD Research Institute, St Louis University School of Medicine, St Louis, Missouri"},{"name":"Department of Psychiatry and Behavioral Neuroscience, St Louis University School of Medicine, St Louis, Missouri"},{"name":"Department of Health and Clinical Outcomes Research, St Louis University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9","key":"ooi250054r1","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1093\/annonc\/mdm056","article-title":"Prevalence of pain in patients with cancer: a systematic review of the past 40 years.","volume":"18","author":"van den Beuken-van Everdingen","year":"2007","journal-title":"Ann Oncol"},{"issue":"5","key":"ooi250054r2","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1007\/s00520-018-4404-x","article-title":"Patients with head and neck cancer may need more intensive pain management to maintain daily functioning: a multi-center study.","volume":"27","author":"Cho","year":"2019","journal-title":"Support Care Cancer"},{"issue":"2","key":"ooi250054r3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.jcrpr.2017.12.003","article-title":"Coordinating pain control in newly diagnosed head\/neck cancer: from a case report to a multi-disciplinary approach.","volume":"5","author":"Kennedy","year":"2018","journal-title":"J Cancer Res Pract"},{"key":"ooi250054r4","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1758-3284-1-26","article-title":"Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy.","volume":"1","author":"Epstein","year":"2009","journal-title":"Head Neck Oncol"},{"issue":"4","key":"ooi250054r5","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1001\/jamaoto.2017.3343","article-title":"Opioid prescription patterns among patients with head and neck cancer.","volume":"144","author":"Sethi","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"3","key":"ooi250054r6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1177\/0194599818808513","article-title":"Short- and long-term opioid use in patients with oral and oropharynx cancer.","volume":"160","author":"McDermott","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"ooi250054r7","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1177\/0194599818778276","article-title":"Persistent postoperative opioid use in older head and neck cancer patients.","volume":"160","author":"Saraswathula","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"15","key":"ooi250054r8","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2014United States, 2016.","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"issue":"2","key":"ooi250054r9","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jpainsymman.2020.08.015","article-title":"Exploring factors associated with long-term opioid therapy in cancer survivors: an integrative review.","volume":"61","author":"Jones","year":"2021","journal-title":"J Pain Symptom Manage"},{"issue":"1","key":"ooi250054r10","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1002\/cncr.33881","article-title":"Substance use and mental health burden in head and neck and other cancer survivors: a National Health Interview Survey analysis.","volume":"128","author":"Balachandra","year":"2022","journal-title":"Cancer"},{"issue":"31","key":"ooi250054r11","doi-asserted-by":"publisher","first-page":"3540","DOI":"10.1200\/JCO.2014.56.0086","article-title":"Four-week prevalence of mental disorders in patients with cancer across major tumor entities.","volume":"32","author":"Mehnert","year":"2014","journal-title":"J Clin Oncol"},{"issue":"12","key":"ooi250054r12","doi-asserted-by":"publisher","first-page":"2809","DOI":"10.1002\/pon.4893","article-title":"Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer\u2014results from a national study.","volume":"27","author":"Rohde","year":"2018","journal-title":"Psychooncology"},{"issue":"6","key":"ooi250054r13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-037918","article-title":"Comparison of prevalence and associated factors of depressive disorder between patients with head and neck cancer and those with lung cancer at a tertiary hospital in Taiwan: a cross-sectional study.","volume":"10","author":"Lee","year":"2020","journal-title":"BMJ Open"},{"key":"ooi250054r14","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-024-01740-x","article-title":"Depression, non-medical pain prescriptions, and suicidal behavior in cancer survivors.","author":"Mwobobia","year":"2025","journal-title":"J Cancer Surviv"},{"issue":"20","key":"ooi250054r15","doi-asserted-by":"publisher","first-page":"4072","DOI":"10.1002\/cncr.31675","article-title":"Suicide risk among cancer survivors: head and neck versus other cancers.","volume":"124","author":"Osazuwa-Peters","year":"2018","journal-title":"Cancer"},{"key":"ooi250054r16","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1016\/j.pain.2013.09.009","article-title":"Opioid therapy for chronic pain in the United States: promises and perils.","volume":"154 Suppl 1","author":"Sullivan","year":"2013","journal-title":"Pain"},{"issue":"2","key":"ooi250054r17","first-page":"167","article-title":"Opioid use in patients undergoing treatment for oral cavity cancer.","volume":"13","author":"Ko","year":"2020","journal-title":"J Pain Manag"},{"issue":"6","key":"ooi250054r18","doi-asserted-by":"publisher","first-page":"E1888","DOI":"10.1002\/lary.29276","article-title":"Opioid usage and prescribing predictors following transoral robotic surgery for oropharyngeal cancer.","volume":"131","author":"Abt","year":"2021","journal-title":"Laryngoscope"},{"issue":"9","key":"ooi250054r19","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1002\/lary.27791","article-title":"Chronic opioid use in patients undergoing treatment for oropharyngeal cancer.","volume":"129","author":"Silver","year":"2019","journal-title":"Laryngoscope"},{"issue":"4","key":"ooi250054r20","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1002\/hed.26034","article-title":"Long-term opioid use in curative-intent radiotherapy: one-year outcomes in head\/neck cancer patients.","volume":"42","author":"Schumacher","year":"2020","journal-title":"Head Neck"},{"issue":"6","key":"ooi250054r21","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1634\/theoncologist.2013-0001","article-title":"Predictors of long-term opioid treatment among patients who receive chemoradiation for head and neck cancer.","volume":"18","author":"Kwon","year":"2013","journal-title":"Oncologist"},{"issue":"4","key":"ooi250054r22","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/hed.26591","article-title":"Chronic opioid use after laryngeal cancer treatment.","volume":"43","author":"Starr","year":"2021","journal-title":"Head Neck"},{"issue":"8","key":"ooi250054r23","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1177\/00034894211045771","article-title":"Long-term opioid use in post-surgical management of patients with head and neck cancer.","volume":"131","author":"Wang","year":"2022","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"5","key":"ooi250054r24","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1093\/pm\/pnz242","article-title":"Persistent and chronic postoperative opioid use in a cohort of patients with oral tongue squamous cell carcinoma.","volume":"21","author":"Cata","year":"2020","journal-title":"Pain Med"},{"issue":"1","key":"ooi250054r25","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1002\/pon.4917","article-title":"Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post-head and neck cancer diagnosis: a longitudinal study.","volume":"28","author":"Henry","year":"2019","journal-title":"Psychooncology"},{"issue":"4","key":"ooi250054r26","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1177\/1062860606288243","article-title":"Are claims data accurate enough to identify patients for performance measures or quality improvement?\u2014the case of diabetes, heart disease, and depression.","volume":"21","author":"Solberg","year":"2006","journal-title":"Am J Med Qual"},{"issue":"1","key":"ooi250054r27","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1177\/1062860609346347","article-title":"Using administrative data to identify mental illness: what approach is best?","volume":"25","author":"Frayne","year":"2010","journal-title":"Am J Med Qual"},{"issue":"5","key":"ooi250054r28","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.jpain.2016.01.474","article-title":"Pain sensitivity in patients with major depression: differential effect of pain sensitivity measures, somatic cofactors, and disease characteristics.","volume":"17","author":"Hermesdorf","year":"2016","journal-title":"J Pain"},{"issue":"5","key":"ooi250054r29","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/pon.1431","article-title":"Are cancer pain and depression interdependent?\u2014a systematic review.","volume":"18","author":"Laird","year":"2009","journal-title":"Psychooncology"},{"issue":"9","key":"ooi250054r30","doi-asserted-by":"publisher","first-page":"721","DOI":"10.7326\/M19-3600","article-title":"Predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries in adults: a systematic review and meta-analysis of observational studies.","volume":"173","author":"Riva","year":"2020","journal-title":"Ann Intern Med"},{"issue":"9","key":"ooi250054r31","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3928\/00485713-20080901-01","article-title":"Sleep disturbances in cancer.","volume":"38","author":"Liu","year":"2008","journal-title":"Psychiatr Ann"},{"key":"ooi250054r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.101978","article-title":"Association of opioid misuse with anxiety and depression: a systematic review of the literature.","volume":"84","author":"Rogers","year":"2021","journal-title":"Clin Psychol Rev"},{"issue":"10","key":"ooi250054r33","first-page":"19","article-title":"Anxiety and Substance Use Disorders: A Review.","volume":"25","author":"Smith","year":"2008","journal-title":"Psychiatr Times"},{"issue":"1","key":"ooi250054r34","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1001\/jamaoto.2017.1880","article-title":"Association between head and neck squamous cell carcinoma survival, smoking at diagnosis, and marital status.","volume":"144","author":"Osazuwa-Peters","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi250054r35","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1038\/s41416-022-01945-w","article-title":"Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis.","volume":"127","author":"Caini","year":"2022","journal-title":"Br J Cancer"},{"key":"ooi250054r36","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.106072","article-title":"Tobacco cessation after head and neck cancer diagnosis is an independent predictor of treatment response and long-term survival.","volume":"134","author":"Krutz","year":"2022","journal-title":"Oral Oncol"},{"issue":"6","key":"ooi250054r37","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1002\/cncr.34620","article-title":"Cigarette smoking cessation, duration of smoking abstinence, and head and neck squamous cell carcinoma prognosis.","volume":"129","author":"Lee","year":"2023","journal-title":"Cancer"},{"issue":"7","key":"ooi250054r38","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1001\/jamaoto.2022.0810","article-title":"Persistent tobacco use after treatment for head and neck cancer.","volume":"148","author":"Van Heest","year":"2022","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi250054r39","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1111\/j.1365-2354.2007.00815.x","article-title":"Smoking cessation among patients with head and neck cancer: cancer as a \u2018teachable moment\u2019.","volume":"17","author":"Sharp","year":"2008","journal-title":"Eur J Cancer Care (Engl)"},{"issue":"1","key":"ooi250054r40","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1002\/hed.26478","article-title":"Trends in chronic opioid therapy among survivors of head and neck cancer.","volume":"43","author":"Kriplani","year":"2021","journal-title":"Head Neck"},{"issue":"1","key":"ooi250054r41","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s12888-020-2456-1","article-title":"Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness.","volume":"20","author":"Owen-Smith","year":"2020","journal-title":"BMC Psychiatry"},{"issue":"6","key":"ooi250054r42","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.7367","article-title":"Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis.","volume":"3","author":"Lawal","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"9","key":"ooi250054r43","doi-asserted-by":"publisher","first-page":"e2332507","DOI":"10.1001\/jamanetworkopen.2023.32507","article-title":"State-to-state variation in opioid dispensing changes following the release of the 2016 CDC guideline for prescribing opioids for chronic pain.","volume":"6","author":"Lyu","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"5","key":"ooi250054r44","doi-asserted-by":"publisher","first-page":"e259043","DOI":"10.1001\/jamanetworkopen.2025.9043","article-title":"The 2016 CDC opioid guideline and analgesic prescribing patterns in older adults with cancer.","volume":"8","author":"Rodin","year":"2025","journal-title":"JAMA Netw Open"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2838194\/jamaotolaryngology_osazuwapeters_2025_oi_250054_1764617474.01322.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T16:00:40Z","timestamp":1765468840000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2838194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":44,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.2649","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}