Cumulative Incidence and Risk of Depression After Opioid Use in Head and Neck Cancer Patients

BACKGROUND: This study examined the relationship between postoperative opioid duration and new-onset depression following head and neck cancer (HNC) surgery. METHODS: We conducted a retrospective review of opioid-naïve patients undergoing HNC surgery from 2007 to 2020, using national Veterans Health Administration claims data. Postoperative opioid duration was categorized as 1-30 days, 31-90 days, or > 90 days (long-term opioid therapy [LTOT]). The primary outcome was new-onset depression within 24 months. Competing risk survival models with entropy balancing evaluated associations. RESULTS: Among 9148 patients, 24.3% received LTOT. Rates of new-onset depression per 1000 person-years were 46.8 (1-30 days), 70.2 (31-90 days), and 88.4 (LTOT). LTOT was associated with a 20% increased risk of depression compared with 1-30 days of use. LTOT was associated with higher rates of comorbidities, non-cancer pain, anxiety, substance use, and preoperative benzodiazepine use. CONCLUSION: LTOT was independently associated with higher risk of depression after HNC surgery.