Racial, Ethnic, and Socioeconomic Discrepancies in Opioid Prescriptions Among Older Patients With Cancer

Vitzthum, Lucas K.; Nalawade, Vinit; Riviere, Paul; Sumner, Whitney; Nelson, Tyler J.; Mell, Loren K.; Furnish, Timothy; Rose, Brent S.; Martı́nez, Marı́a Elena; Murphy, James D.

doi:10.1200/op.20.00773

Cited by 19 publications

(19 citation statements)

References 42 publications

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Section: Health Disparitiesmentioning

confidence: 99%

“…96 The most vulnerable patients remain the most affected, with reduced rates of opioid prescribing, along with lower doses, reported in people of color. 99,100 When provided a prescription for an opioid, patients with cancer consistently recount problems obtaining the medication, with one quarter describing perceived difficulties during interactions with pharmacy staff. 101 Some of these problems arise because of the complexities of medication dispensing in our current health care system.…”

Section: Barriers To Opioid Accessmentioning

confidence: 99%

“…110,111 In the case of opioids, prescribing in the United States varies by age, sex, gender, race, and ethnicity. 96,99,100,112 A 2020 analysis of linked Surveillance, Epidemiology, and End Results-Medicare data assessed opioid prescriptions among opioid-naive, older patients with nonmetastatic cancer. 99…”

Section: Health Disparitiesmentioning

confidence: 99%

“…96,99,100,112 A 2020 analysis of linked Surveillance, Epidemiology, and End Results-Medicare data assessed opioid prescriptions among opioid-naive, older patients with nonmetastatic cancer. 99 Compared with non-Hispanic White patients, the likelihood of a new opioid prescription was lower in non-Hispanic Black patients (odds ratio [OR], 0.75; 95% CI, 0.67 to 0.84), nonsignificantly higher in Hispanic patients (OR, 1.14; 95% CI, 0.99 to 1.30), and higher in Asian-Pacific Islander patients (OR, 2.15; 95% CI, 1.85 to 2.50). In addition, many patients lack access to care because of their geographic location and distance from appropriate treatment facilities.…”

Section: Health Disparitiesmentioning

confidence: 99%

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Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

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PURPOSE To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time. RECOMMENDATIONS Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Additional information is available at www.asco.org/supportive-care-guidelines .

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Section: Health Disparitiesmentioning

confidence: 99%

Section: Barriers To Opioid Accessmentioning

confidence: 99%

Section: Health Disparitiesmentioning

confidence: 99%

Section: Health Disparitiesmentioning

confidence: 99%

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Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

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“…Emerging evidence suggests that there are disparities in pain management in both oncology and health care in general on the basis of race, ethnicity, socioeconomic status, and other sociodemographic factors. 23,24 We hypothesized that similar disparities exist in pain management in HNC, for which there currently exists no universally accepted postoperative pain assessment or management regimen. 13 There are existing studies of opioid use in HNC 14,19,22,25,26 ; however, little is known about differences in pain management in this population.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

Canick

Bhardwaj²,

Patel³

et al. 2023

JCO Oncology Practice

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PURPOSE: While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. METHODS: We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. RESULTS: Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). CONCLUSION: We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.

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Racial disparities in opioid prescription and pain management among breast cancer survivors

et al. 2023

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Background We examined whether there are racial disparities in pain management, opioid medicine prescriptions, symptom severity, and quality of life constructs in breast cancer survivors. Methods We conducted a secondary analysis of longitudinal data from the Women's Hormonal Therapy Initiation and Persistence (WHIP) study (n = 595), a longitudinal study of hormonal receptor‐positive breast cancer survivors. Upon study enrollment, patients completed a survey assessing an array of psychological, behavioral, and treatment outcomes, including adjuvant endocrine therapy (AET)‐induced symptoms, and provided a saliva biospecimen. Opioid prescription records were extracted from the health maintenance organizations (HMOs) pharmacy database. The final analytic sample included women with complete HMO pharmacy records for 1 year. Results There were 251 eligible patients, of which 169 (67.3%) were White. The average age was 61.09 years old (SD = 11.07). One hundred seventy‐two patients (68.5%) had received at least one opioid medication and 37.1% were prescribed opioids longer than 90 days (n = 93). Sixty‐four Black patients (78%) had a record of being prescribed with opioids compared to 64% of White patients (n = 108, p = 0.03). Black patients reported worse vasomotor, neuropsychological, and gastrointestinal symptoms, as well as lower quality of life and greater healthcare discrimination than White patients (p's < 0.05). Black patients were more likely to be prescribed opioids for 90 days or longer compared to White patients, when controlling for age, marital status, income, body mass index (BMI), cancer stage, and chemotherapy status (adjusted Odds Ratio = 2.72, p = 0.014). Conclusion Findings indicate that there are racial differences in opioid prescriptions supplied for pain management and symptomatic outcomes. Future research is needed to understand the causes of disparities in cancer pain management and symptomatic outcomes.

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Racial, Ethnic, and Socioeconomic Discrepancies in Opioid Prescriptions Among Older Patients With Cancer

Cited by 19 publications

References 42 publications

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

Racial disparities in opioid prescription and pain management among breast cancer survivors

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