Examining pain among non‐Hispanic Black and non‐Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network)

Abstract

Pain is common in patients with cancer 1 seeking emergency department (ED) care. 2 Fifty percent of ED patients with cancer present with pain and 39% report pain at final ED pain assessment. 3 Thus, ED practitioners seemingly remain challenged to manage pain in this population. Such findings support calls encouraging safe, effective, and timely pain management in EDs. 4 Brown and colleagues 5 encourage research into any racial or socioeconomic gaps in the treatment of pain in ED cancer patients. The purpose of this prospective cohort study was to assess the presence of pain management disparities in this cohort of ED cancer patients stratified by race. This is a secondary analysis of prospectively collected data from The Comprehensive Oncologic Emergencies Research Network (CONCERN), a National Cancer Institute (NCI)sponsored multicenter research consortium. CONCERN conducted a multicenter prospective cohort study of 18 EDs from March 1, 2016, through January 30, 2017. The parent study methods and population have been previously described. 6 Briefly, study participants were adults aged ≥18 years with active cancer who presented to the ED. Active cancer was defined as (1) ongoing (or within 12 months) antineoplastic therapy (radiotherapy, chemotherapy, cancer-related surgery, or other); (2) previously identified or ED physician-identified cancer recurrence or metastasis; or (3) cancer-related symptoms. Participants were excluded for the following reasons: pregnancy, incarceration, a psychiatric chief complaint, primary evaluation as a trauma response, non-English speaking, previous enrollment, or too ill or otherwise unable to participate in survey administration. Due to limited numbers of Hispanic participants, this study does not provide specific analyses of ethnicity. The study's null hypothesis was that there is no difference between non-Hispanic Black (NHB) and non-Hispanic White (NHW) in pain reports or treatment. Each site received institutional review board approval. All participants provided written informed consent; no incentive was provided. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.