Opioid use during definitive chemoradiotherapy for esophageal cancer: A retrospective analysis

Background Definitive chemoradiotherapy represents an alternative treatment option for esophageal cancer patients who are not considered candidates for resection or refuse surgery. Swallowing pain associated with chemoradiotherapy is a serious adverse event that disrupts patient quality of life; however, there are no comprehensive reports describing opioid management during chemoradiotherapy for esophageal cancer. We conducted a study to determine the proportion of patients who required opioids, the timing of opioid initiation, the amount and type of opioids used, and other factors for patients requiring opioids. Methods Data for esophageal cancer patients who had undergone definitive chemoradiotherapy from April 2013 to March 2023 were retrospectively examined using their medical records. Results A total of 141 patients (105 men and 36 women, mean age: 69.6 years old) were included in the analysis, of whom 68 (48.2%) required opioids during chemoradiotherapy, with a median maximum use of 41.25 mg/day and a median cumulative use of 420 mg oral morphine equivalent. Oral or transdermal opioids were administered in most cases, with the proportion of transdermal fentanyl increasing as pain increased. There was a bimodal distribution of opioid initiation with a peak on days 15 and 37 following the start of chemoradiotherapy, and a median on day 22.5. Significant factors associated with opioid use were younger age and concomitant esophageal mucositis, which required intravenous antibiotics. Conclusion Approximately half of the esophageal cancer patients who underwent definitive chemoradiotherapy required opioid pain control. Careful pain management is necessary for each patient.