Pain management practices for outpatients with breast cancer

Pain is a significant problem in patients with breast cancer. Limited data exist regarding the nature and extent of pain management in women with breast cancer visiting outpatient settings. This study examined the pain management practices and the factors associated with prescribing pain medications among breast cancer patients.

This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) 2011-2016, nationally representative outpatient survey data. Women (age ≥18 years) with breast cancer as the primary diagnosis were included. Weighted descriptive analyses examined national-level pain management practices, while multivariable logistic regression evaluated the factors associated with the prescribing of pain medications and opioids.

There were 23.95 million (95% confidence interval [CI], 19.29-28.60) outpatient visits for breast cancer during the study period. Pain medications were prescribed in 27.12% of these visits, with non-opioids prescribed in 17.13% and opioids in 15.16% of visits. Logistic regression analyses revealed that patients on Medicaid/other state-based insurance (odds ratio [OR] =2.38, 95% CI:1.15-4.93), those visiting general/family practice physicians (OR = 3.18, 95% CI:1.22-8.29) and patients receiving adjuvant pain medications (OR = 4.74, 95% CI: 3.10-7.24) were associated with a greater odds of receiving pain medications; while patients who were white (OR = 0.50, 95% CI:0.3-0.85), those residing in the northeast region (OR = 0.31, 95% CI: 0.10-0.99), and non-primary care provider visits (OR = 0.37, 95% CI:0.15-0.94) were associated with lower odds of receiving pain medications. Regional variations were observed among those receiving pain medications: women in the Northeast (OR = 0.06, 95% CI:0.01-0.29), Midwest (OR = 0.15, 95% CI:0.04-0.62), and South (OR = 0.24, 95% CI:0.06-0.92) regions were less likely to receive opioids. However, patients visiting general and family practice specialties (OR = 6.76, 95% CI:1.71-26.70) were more likely to prescribe opioids than non-opioids.

The national survey data revealed one in four women visits and one in seven office visits for breast cancer received pain medication prescriptions and opioid medications, respectively. Both patient and provider characteristics contribute to variations in pain management in breast cancer patients. Further research is needed to evaluate the long-term consequences of these variations in breast cancer.