Abstract B025: Examining the role of perceived respect on racial disparities in cancer-related pain
Authors: Samuel Cleo A. , Schaal Jennifer , Mbah Olive , Eng Eugenia , Robertson Linda , Baker Stephanie , Black Kristin Z. , Dixon Crystal , Ellis Katrina , Guerrab Fatima , Jordan Lauren C. , Lightfoot Alexandra F. , Cykert Samuel 
Published: August 2020

Background: Black cancer patients consistently report worse pain management than White patients. Effective pain management requires communication, and provider respect is linked to positive provider-patient communication. Racial differences in patient perceptions of respect during clinical encounters are well documented and linked to disparities in care, yet little is known about whether racial differences in perceived respect contribute to disparities in cancer pain. As part of the NCI-funded study, Accountability for Cancer Care through Undoing Racism and Equity, we examined whether perceived respect was associated with racial disparities in pain.

Methods: We obtained prospective survey data from Black and White breast and lung cancer patients in active treatment at two cancer centers from 2013-2017. The primary outcome was a binary measure of moderate-to-severe pain based on patient responses to PROMIS items 90 days post-diagnosis. A binary measure of “high” vs “low” respect was computed based on patient responses to a survey item assessing perceived respect from doctors at the last clinic visit. We estimated logistic regressions assessing associations between race and pain 90 days post-diagnosis and the mediating effect of respect, adjusting for patient demographics, baseline pain, clinical characteristics, and site of care.

Results: Compared with Whites (N = 200), Blacks (N = 119) were more likely to report moderate-to-severe pain (26.9% vs. 49.1%; p &lt; .001), but less likely to report “high” respect during their most recent clinic visit (88.9% vs. 82.3%; p = .073), though the racial gap in respect was marginally significant. In adjusted analyses, Black race remained a statistically significantly predictor of moderate-to-severe pain (adjusted odds ratio [AOR] = 2.62; 95%CI:1.35-5.14). “High” respect was associated with less moderate-to-severe pain (AOR = 0.31; 95%CI:0.13-0.72), but racial disparities in pain were not attributable to racial gaps in perceived respect.

Conclusions: Black-White racial disparities in pain exist among cancer patients. While patient perceptions of respect were linked to pain severity and to some extent, race, perceived respect did not explain racial disparities in pain severity.

Citation Format: Cleo A. Samuel, Jennifer Schaal, Olive Mbah, Eugenia Eng, Linda Robertson, Stephanie Baker, Kristin Z. Black, Crystal Dixon, Katrina Ellis, Fatima Guerrab, Lauren C. Jordan, Alexandra F. Lightfoot, Samuel Cykert. Examining the role of perceived respect on racial disparities in cancer-related pain [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B025.