老年头颈癌 (HNC) 幸存者的阿片类药物处方可能不安全，比例令人担忧。确定 HNC 幸存者的阿片类药物处方者的专业性对于确定阿片类药物安全干预措施的设置至关重要。这项研究假设肿瘤科和外科手术提供者主要负责治疗后一年内的阿片类药物处方，但随着时间的推移，初级保健提供者 (PCP) 越来越多地参与处方。使用关联的监测、流行病学和最终结果医疗保险数据，进行回顾性研究对 2014 年至 2017 年间诊断为 I-III 期 HNC 的年龄 >65 岁且截至 2019 年有≥6 个月无治疗随访的成年人进行了分析。从治疗完成开始，阿片类药物填充被分配给处方医生专业：肿瘤学、外科、初级保健、疼痛管理或其他。总结了每年随访的处方者模式。多项逻辑回归模型捕获了每个专业开出阿片类药物的可能性。在 5135 名 HNC 幸存者中，2547 名 (50%) 的阿片类药物填充量≥1 次（中位值，2.1 年随访）。 47% 的药物由 PCP 处方（每年 42%-55%）。 PCP 向 45% 的阿片类药物填充量≥1 的幸存者开了阿片类药物，这一比例高于其他专业人士。 PCP 比肿瘤科医生或外科医生开出更长的阿片类药物供应量（中位，20 天/次；中位，30 天/年）。肿瘤科医生开出阿片类药物的可能性比 PCP 开出阿片类药物的可能性低四倍。在 HNC 存活期间，PCP 参与阿片类药物处方的比例仍然很高。提高阿片类药物处方安全性的干预措施应针对初级保健，这是非癌症人群中阿片类药物减少工作的典型做法。© 2024 美国癌症协会。

Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time.Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty.Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP.PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.© 2024 American Cancer Society.