Racial and Ethnic Disparities in Pharmacologic and Non‐Pharmacologic Pain Management Among Older Cancer Survivors

TL;DR

The study finds racial and ethnic disparities in how older cancer survivors receive pain treatments, including both medications and non-drug therapies.

Contribution

The paper provides new empirical evidence on racial disparities in both pharmacologic and non-pharmacologic pain management among older cancer survivors.

Findings

Non-Hispanic Black, Asian/Pacific Islander, and Other race-ethnicity survivors used less pain treatment overall compared to non-Hispanic White survivors.

Minority survivors received lower opioid doses for longer durations but higher non-opioid doses for shorter durations.

Non-Hispanic Black and Hispanic-Latino survivors used fewer non-pharmacologic treatments compared to non-Hispanic White survivors.

Abstract

Pain is common among cancer survivors and often managed with medication; however, racial‐ethnic disparities persist in pain treatment. Given inadequate data on pharmacologic and non‐pharmacologic pain management among minoritized cancer survivors, we investigated these patterns using the SEER‐Medicare claims linked database.

An incident cancer diagnosis cohort (≥ 66 years) was created from 2007 to 2016. The primary outcome was incidence of pain treatment (pharmacologic and non‐pharmacologic) within 90 days post‐diagnosis. Racial disparities were measured as adjusted incidence ratios for treatment using Poisson regression and adjusted differences in supply days and doses using linear regression, comparing non‐Hispanic Black (nHB), Hispanic‐Latino (LatinX), Asian/Pacific Islander (API), and Others to non‐Hispanic White (nHW). Models were adjusted for demographic and clinical variables.

Among 300,048 survivors—nHW (72.9%), nHB (9.6%), LatinX (8.8%), API (7.3%), Others (1.4%)—nHB (aIR = 0.96, 95% CI, 0.95–0.98), API (aIR = 0.96, 95% CI, 0.95–0.98) and Others (aIR = 0.91, 95% CI, 0.87–0.94) used less pain treatment overall than nHW. Opioids (80% of treatments) were less frequently utilized by males of the Other race‐ethnicity group (aIR = 0.75, 95% CI, 0.70–0.81), compared to nHW males. For non‐opioids, nHB males (aIR: 0.84, 95% CI, 0.79–0.88) were less likely to use these therapies as compared to nHW males. Non‐pharmacological treatments were less utilized by nHB (aIR = 0.65, 95% CI, 0.62–0.69) and LatinX survivors (aIR = 0.69, 95% CI, 0.65–0.73), as compared to nHWs. Minority survivors received lower opioid doses for longer durations, but higher non‐opioid doses for shorter durations.

There are considerable racial‐ethnic disparities in the utilization of pharmacologic and non‐pharmacologic pain treatments among cancer survivors. Future research should explore the drivers of these inequities.

Figures