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Minorities twice as likely to have undertreated pain

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2011 ASCO Annual Meeting

CHICAGO – Minority patients are 50% more likely to receive inadequate treatment for their cancer-related pain, according to results from a prospective and observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung or prostate cancer.

Michael Fisch, MD, MPH, chair of the department of general oncology in the division of cancer medicine at the University of Texas MD Anderson Cancer Center said that these results show that, unlike previous studies, age did not appear to be a barrier to receiving adequate treatment for pain. Non-Hispanic white patients were far less likely to get inadequate pain treatment compared with minority patients, even after adjusting for other explanatory variables in the multivariate analysis (OR= 0.51; 95% CI, 0.37-0.70).

“Cancer pain remains prevalent in ambulatory patients with common solid tumors,” he said. “Gender and age do not seem to be any longer predictors of treatment adequacy.”

Fisch presented the results at the 2011 ASCO Annual Meeting.

Other significant predictors of inadequate pain treatment were good performance status, treatment at a minority site and having non-advanced disease without concurrent treatment.

Researchers evaluated 3,123 ambulatory patients with any stage of invasive cancer who were treated at 38 sites, including 13-minority-based sites. Patients completed a 25-item measure of pain, functional interference and other symptoms at baseline and again roughly 4 weeks later. Providers recorded data on analgesic prescribing.

The pain management index was calculated by subtracting the pain score from the analgesic score to assess treatment adequacy. Fisch said that a score of less than zero is defined as under-treatment.

More than two-thirds of patients reported pain or required analgesics. Of those, 670 had inadequate analgesic prescribing. Overall, 584 patients (19.3%) reported moderate or severe pain and 40% of those patients did not receive an opioid analgesic. Physicians prescribed strong opioids for 13.4% of patients.

Physicians determined that pain was the top symptom in 21.5% of patients, and one of the top three symptoms for 35.2%. – by Jason Harris

For more information:

• Fisch M. #6008. Presented at: 2011 ASCO Annual Meeting; June 3-7; Chicago.

Disclosure: Dr. Fisch reported no relevant financial disclosures.

The good news is that two-thirds of patients with pain at initial assessment had acceptable pain management. The other good news is that the traditional barriers to getting good pain management — female gender and older age — were not barriers in this sample. Less than good news: one-third of patients with pain did not have acceptable pain management. That is a lot of people. The study results also point to the fact that barriers to treatment remain, mainly to those of minority status. Pain undeniably remains undertreated as a symptom.

- Susan Yount, PhD
Research Assistant Professor in the Department of Medical Social Sciences,
Northwestern University Feinberg School of Medicine.

Disclosure: Dr. Yount reported no relevant financial disclosures.

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