Does recreational drug use influence survival and morbidity associated with laryngeal cancer

Document Type : Original Article


ENT Department, Queen Elizabeth University Hospital, Glasgow, G51 4TF



Background: The use of opioids is considered a risk factor for laryngeal cancer. A retrospective study was 
performed to explore the relationship between recreational drug exposure and laryngeal cancer.

Methods: Patients diagnosed between the 1st of January 2013 and the 31st of December 2017 using ICD-10 
CD-32 coding were identified from the Head and Neck Multidisciplinary Team database. We divided the 
study population into two cohorts (RD and non-RD) and compared the demographics, morbidity, and 
outcomes of these two populations. In addition, we performed case-matched analysis to control for potential 
confounding factors including gender, alcohol use and cigarette smoking.

Findings: 329 patients in Glasgow, Scotland were included with a mean age of 64.96 ± 10.94 and a follow-up 
of 24 ± 13.91 months. Of these, 39 reported recreational drug use (RD). RD was associated with younger age 
(53.0 vs. 66.6, p<0.001) at diagnosis with laryngeal cancer. A greater proportion of tumours occurred in the 
supraglottic subsite (p=0.041). Furthermore, these patients were more likely to undergo tracheostomy 
(RR=2.50, 95% CI: 1.41-4.44, p=0.008) and laryngectomy (RR=2.25, 95% CI: 1.57-3.21, p<0.001). 
Recreational drug users were more likely to require enteral feeding support (RR= 1.44, 95% CI: 1.13-1.84, 
p=0.02) during oncological treatment. No survival differences were noted at 1, 2, or 3-years (plog-rank=0.83). 
Case matched analysis correcting for smoking, alcohol and gender confirmed that recreational drug users 
were younger at diagnosis with a predilection for the supraglottic subsite.

Conclusion: Recreational drug use is associated with an increased burden of disease and morbidity in 
laryngeal cancer. We suggest that clinicians view recreational drug exposure as a red flag in those with 
suspected laryngeal cancer regardless of patient age.