Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device

Abstract

Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and Whites using Medication Event Monitoring System [MEMS]. Patients (n=207) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia [≥18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least one prescription of oral around-the-clock analgesic (ATC)]. African Americans reported significantly greater cancer pain (P<.001), were less likely than Whites to have a prescription of long acting opioids (P<.001), and more likely to have a negative pain management index (P<.001). There were considerable differences between African Americans and Whites in the overall MEMS dose adherence, i.e., percentage of the total number of prescribed doses that were actually taken (53% vs. 74%, P<.001). On sub-analysis, analgesic adherence rates for African Americans ranged from 34% (for weak opioids) to 63% (for long acting opioids). Unique predictors of analgesic adherence varied by race; income levels, analgesic side-effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for Whites.

Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time

“…It is difficult to compare the adherence data in the literature because investigators used various methods to measure adherence (Table ). In general, 3 methods to measure adherence can be distinguished: (1) a questionnaire or statement that reflects patients' intention to be adherent (eg, Morisky Medication Adherence Scale); (2) interviews or statements aimed to distinguish patients who were adherent to the prescribed analgesics from those who were not; and (3) measurements of the ratio of analgesic doses taken by patients with respect to the analgesic doses prescribed (analgesic use ratio) . These described adherence rates should be interpreted differently.…”

“…Therefore, it is hard to compare the adherence rates of both methods. The studies that used multiple adherence measurements did not compare those methods . In general, the results of all 3 methods were mentioned adherence.…”

Culturally Responsive Pain Management for Black Older Adults

“…Table 2 provides an overview of considerations for various medication classes used to treat mild, moderate, and severe pain in Black older adults. When treating severe pain in particular, nurses should be mindful that Black Americans report significantly greater cancer pain (P<.001), are less likely than Whites to have a prescription for a long acting opioids (P<.001), and are more likely to have a negative pain management index (score of how well pain is managed) (P<.001) (Meghani, Thompson, Chittams, Bruner, & Riegel, 2015). Furthermore, when Black elders do use a prescription opioid, they are more likely to take less than the prescribed amount.…”

“…Furthermore, when Black elders do use a prescription opioid, they are more likely to take less than the prescribed amount. In one study, on sub-analysis, analgesic adherence rates for Black Americans ranged from 34% (for weak opioids) to 63% (for long acting opioids) (Meghani et al, 2015). A primary reason for decreased opioid compliance amongst Black older adults is concern about side effects.…”

“…Side effects are a commonly reported barrier to medication utilization and adherence in older Blacks adults (Staja Q. Booker, 2015; Meghani et al, 2015; Robinson, 2015). Not unlike other older adults, Black elders often have several comorbidities (i.e., 3 or more) with each requiring separate treatments and medications.…”