Abstract 754: Exploring racial and ethnic disparities in pain medication use in patients with colorectal cancer
Authors: Allen John M. , Awunti MegCholack , Guo Yi , Rogers Sherise C. , Scarton Lisa , Wilkie Diana J. 
Published: June 2023

Background: Pain management is a substantial component of treating patients with colorectal cancer (CRC). CRC-related pain occurs in over 70% of patients and is among the most frequently reported adverse events in this patient population. CRC-related pain is multifactorial and includes nociceptive, neuropathic, and psychogenic origins. CRC-related pain is primarily managed by medications, including opioid and non-opioid analgesics, corticosteroids, and antiepileptics. Among these, opioids are by far the most utilized treatment. Prior literature suggests racial and ethnic differences in the use of some pain medications, including opioids, in patients with cancer, but there is no research confirming these findings in patients with CRC.

Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database, our analysis included all patients with a CRC diagnosis and a newly initiated outpatient prescription claim for pain medications from 2009-2018. Patients on pain medications before CRC diagnosis or of unspecified race or ethnicity were excluded from the analysis. We assessed three classes of pain medications, including opioids, non-opioid analgesics, and neuropathic analgesics. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Our objective was to characterize the relationship between race and receipt of pain medications in the first year following the diagnosis of CRC.

Results: After the application of the inclusion/exclusion criteria, 136,014 patients with CRC were identified and included in the analysis (White: 81.6%; Black/African American: 11.2%; Asian/Pacific Islander: 4.3%; Hispanic: 2.6%; Native American 0.29%). As compared to White patients, Black/African American (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI]: 0.92-0.99) and Asian/Pacific Islander patients (OR 0.75; 95% CI: 0.71-0.79) were less likely to be prescribed an opioid analgesic, while Native American patients were more likely (OR 1.42; 95% CI: 1.16-1.73). Asian/Pacific Islander (OR 1.60; 95% CI: 1.48-1.73) and Hispanic (OR 1.57; 95% CI: 1.42-1.73) patients were more likely to be prescribed a non-opioid analgesic as compared to White patients. Black/African American (OR 1.06; 95% CI: 1.01-1.12) and Native American (OR 1.57; 95% CI: 1.22- 2.03) patients were more likely to be prescribed a neuropathic analgesic compared to White patients. No other differences were noted in pain medication use by race or ethnicity.

Conclusion: Our study findings suggest that pain medication usage in patients with CRC varies for patients from historically minoritized racial and ethnic groups compared to White patients. Future research should explore the barriers and facilitators of pain medication usage patterns in patients from historically minoritized racial and ethnic groups with CRC.

Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Diana J. Wilkie. Exploring racial and ethnic disparities in pain medication use in patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 754.