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

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.