Cancer patients are often prescribed pain medications, for example during recovery from surgical procedures. However, for many cancer patients, the use of opioid pain medications during treatment can be a gateway to misuse or addiction once treatment ends. Now with cancer patients living longer than ever before, protecting quality of life in the months, years, or decades after treatment is becoming increasingly important, including guarding against the risk of opioid addiction.
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"We felt like it was long term problem for some of our head and neck cancer patients, but didn't know how much of problem," says first author Jessica McDermott, MD, investigator at CU Cancer Center and assistant professor at the CU School of Medicine.

To discover the extent of opioid use and abuse in head and neck cancer patients, McDermott and colleagues searched the SEER/Medicare database to identify 976 patients treated between 2008 and 2011 for oral or oropharynx cancer. In all, 811 of these patients received prescriptions for opioid pain medications during treatment. Three months after treatment ended, 150 of these patients continued to have active opioid prescriptions. Six months after treatment, 68 patients or 7 percent of the total population continued to use opioid pain medication. Results are published online ahead of print in the journal Otolaryngology-Head and Neck Surgery.

"You shouldn't need opioids at the six-month point," McDermott says. "We hope that we can use this data to help patients manage pain better."

Older adults with cancer are more likely to have had a heart attack or stroke in the months prior to their cancer diagnosis compared with similar adults who do not have cancer during the same period, according to a report published online in Blood. Lung and colon cancers, as well as advanced-staged cancers, appear to be most strongly associated with an elevated risk of heart attack and stroke caused by blood clots in the arteries.

The study is the largest and most systematic evaluation of these events leading up to a cancer diagnosis, according to researchers at Weill Cornell Medicine, New York-Presbyterian, and Memorial Sloan Kettering Cancer Center in New York City.

"Our data show there is an associated risk of ischemic stroke and heart attack that begins to increase in the five months before the cancer is officially diagnosed and peaks in the month just before," said lead study author Babak Navi, MD, MS, an associate professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. "These results suggest that cancer's effect on the clotting system may be what's predominantly driving the associated risk of heart attacks and stroke."

Cancers can take months and sometimes years to develop and be diagnosed, and some cancers may be exerting biological effects on the body, especially thromboembolic activity, before they come to medical attention, he explained.

Researchers used information from a Medicare database linked to the Surveillance, Epidemiology, and End Results (SEER) registry and retrospectively looked at the risk of heart attack and stroke in people 67 years and older who were newly diagnosed with breast, lung, prostate, colorectal, bladder, non-Hodgkin lymphoma, uterine, pancreatic, and gastric cancers from January 1, 2005, to December 31, 2013. Together, these cancers account for two-thirds of all cancer diagnoses in the United States. The study included 748,662 Medicare beneficiaries and compared patients with cancer to matched controls during the 360 days before the cancer diagnosis.
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Overall, the risk of having a heart attack and stroke jumped by 70 percent in the year before cancer diagnosis. The risk was most acute in the month immediately before cancer diagnosis. During this time, patients who were later diagnosed with cancer were more than five times more likely to have a heart attack or stroke compared with those who did not have cancer - 2,313 of cancer patients had an event compared with 413 of matched controls. Beyond five months before a cancer diagnosis, the risks of these events were similar in both groups. The rate of heart attack or stroke was highest in adults with lung and colorectal cancers and those with stage 3 or 4 disease. When analyzed separately, both heart attack and stroke risk were increased in the months before cancer diagnosis, although heart attack events were slightly more common than strokes. Secondary analyses of additional arterial thromboembolic event types (i.e., thromboembolism of arteries supplying the peripheral limbs or mesentery) further substantiated the primary findings.