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Pain and Opioid Use Among Black and White Patients With Cancer Using Remote Symptom Monitoring
Joud El Dick1, Sandra Olisakwe1, Courtney P Williams2
1Division of Hematology and Oncology (J.E.D., S.O., A.A., N.L.H., G.B.R.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
Context:
Black patients with cancer report higher pain and are often undertreated compared with White patients. Remote symptom monitoring (RSM) using electronic patient-reported outcomes may standardize pain assessment.
Objectives:
To examine whether racial differences in pain severity reporting or opioid use persist among cancer patients enrolled in an RSM program.
Methods:
We conducted a secondary analysis of a hybrid type 2 single-group trial of adult cancer patients enrolled in an RSM program at the University of Alabama at Birmingham (2020-2023). Weekly PROCTCAE surveys assessed pain. Opioid use before and during enrollment was extracted from the electronic health record. Multivariable mixed models evaluated associations between race, pain severity, and opioid use.
Results:
Among 913 patients, 73% were White and 27% Black. Black patients more frequently had obesity, breast cancer, and late-stage cancer. Pain severity reporting was similar between racial groups at 0-3 and 4-6 months after enrollment. In adjusted analyses, Black patients had similar probabilities of moderate to severe pain compared with White patients (RR 1.03, 95% CI, 0.84-1.26). Pre-RSM opioid use was higher among Black patients (61% vs. 53%) and declined during RSM for both groups (40% vs. 32%). Opioid users were more likely to report moderate to severe pain than nonusers (RR 1.57-2.02), with similar predicted probabilities across race.
Conclusion:
Pain severity and the association between opioid use and pain were similar between Black and White patients enrolled in RSM, and opioid prescribing decreased for both groups, suggesting RSM may support more equitable cancer pain management.
