Pain Disparities Among Asian Americans Affected by Cancer: The Role of Depressive Symptoms

Although racial and ethnic cancer pain disparities are well-documented, there is insufficient Asian American representation in extant literature, leading to inadequate knowledge about pain outcomes in this population. In addition, the prevalence of depression and its relationship with cancer pain in Asian American patients are poorly characterized. This study evaluated pain differences between Asian American and white patients with cancer and the role of depressive symptoms.

Data from two randomized clinical trials investigating integrative therapies for chronic musculoskeletal cancer pain were analyzed to examine the association between race and pain interference using bivariate analyses and linear regression models. We pooled participants from both trials, which enrolled cancer patients with pain and used identical pain and depression assessments, to increase the sample size of Asian American cancer patients, a historically underrepresented population in pain and depression research.

Compared to White counterparts, Asian American patients reported greater pain interference (5.5 vs. 4.7, p = 0.016) and depressive symptoms (7.1 vs. 5.9, p = 0.047). The Asian race was associated with pain interference (coef. = 0.83, 95% CI: 0.1 to 1.5, p = 0.016) in bivariate analysis. When depressive symptoms were added to regression models, Asian race was no longer associated with pain interference (coef. = 0.51, 95% CI: -0.09 to 1.1, p = 0.097).

Higher pain interference levels among Asian Americans were partly driven by greater depression severity. These findings highlight the mental health burden among the Asian American cancer population and suggest that treatment for depressive symptoms may need to be incorporated in oncology care and pain management for this population. Importantly, results suggest Asian Americans affected by cancer may be at increased risk for poorly managed pain and depressive symptoms.