(95) The Trends of Racial/Ethnic Disparities in Pain Treatment Among Older Cancer Patients in the US from 2007-2016

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1140

Presenting Author(s)

Macarius M. Donneyong, PhD
– Assistant Professor, The Ohio State University, The Ohio State university, Columbus, Ohio, United States

Co-Author(s)

Mohamed Elsaid
– Division of Biomedical Informatics, College of Medicine, The Ohio State University, United States
Ashley Felix
– Division of Epidemiology, College of Public Health, The Ohio State University, United States

Background: Cancer causes pain. Given that the quality of cancer care is lower among racial/ethnic minorities, it is possible that pain treatment disparities may exist. However, there is inadequate data to assess racial/ethnic disparities in pain treatment especially in older adults among whom cancer is the most prevalent.

Objectives: To describe the patterns and temporal trends of racial/ethnic disparities in use of pharmacologic (opioid and nonopioid) and nonpharmacologic pain treatment among cancer patients (breast, lung, colorectal, prostate, uterine, head and neck).

Methods: An incident cancer diagnosis cohort was created from the 2007-2016 SEER-Medicare claims linked dataset – a large, population-based dataset for older (≥65 years old) cancer patients. Follow-up for the incidence (first time receipt with no prior use) of use of pain treatment commenced on the date of cancer diagnosis through to the 365th date post diagnosis – patients who died within this period were excluded. Poisson regression was used to calculate the adjusted-cumulative incidence rates (aIR) of pain treatment adjusted by age, sex, year of diagnosis and cancer type. Joinpoint regression was used to measure: 1) the average annual percent change (AAPC) which is a single summary of the average trend of race-by-sex age-standardized IR; and 2) racial disparities - measured as the absolute difference (AD) in AAPCs between each minority group (non-Hispanic Black [nHB], Hispanic-Latino [LatinX], Asian/Pacific Islander [API], Others) vs. non-Hispanic Whites (nHW) (referent).

Results: Our analysis involved 471,378 cancer patients – nHW (73.6%), BAA (9.9%), Hispanic (8.6%), Asian (6.6%), Other (1.3%). Overall, opioids were the most frequently used pain treatment with the highest and lowest use observed among LatinX (aIR=64.5%) and Others (aIR=51.1%). nHW (aIR=15.6%) were significantly most likely to use nonpharmacologic treatment compared to the rest. Over time, the rate of opioid use was relatively higher among nHBs (AD=0.4%, P< 0.001) and LatinX (AD=0.7%, P< 0.001) but lower among Others (AD=1.5%, P< 0.001), compared to nHWs. The trends of non-opioid use among nHBs (AD=1.8%, P< 0.001) rose higher than among nHWs. No other disparities in pharmacologic treatment were observed. In contrast, the rates of use of nonpharmacologic treatment were relatively lower among nHBs (AD=2.2%, P= < 0.001) and LatinX (AD=2.0%, P= < 0.001) compared to nHWs.

Conclusions: Disparities in pain treatment were observed by the pain treatment type – racial/ethnic minorities were significantly less likely to use nonpharmacologic treatment. Further analyses are required to examine the drivers of these trends and patterns of pain treatment by race/ethnicity among older cancer patients.