Abstract A026: Disparities in the use of pain medication in patients with pancreatic cancer: Focus on racial and ethnic minorities
Authors: Allen John M. , Awunti MegCholack , Guo Yi , Rogers Sherise , Scarton Lisa , Wilkie Diana J. 
Published: January 2023

Background: Pain management is a substantial component of the care of patients with pancreatic cancer (PC). PC-related pain occurs in up to 75% of patients at diagnosis, 90% of patients with late-stage disease, and overall is the most frequently reported adverse event in this patient population. PC-related pain is multifactorial and includes visceral, somatic, and neuropathic origins. Furthermore, PC-related pain can be disease-induced or a result of adverse side effects of treatment. PC-related pain is primarily managed by supportive care medications (SCM), including opioid and non-opioid analgesics, corticosteroids, and antiepileptics. Among these, opioids are by far the most utilized treatment. Recent evidence suggests that opioid use in PC patients is associated with increased survival. Previous literature suggests racial/ethnic differences in the use of some SCMs including opioids in patients with cancer, but there is no research confirming these findings in patients with PC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a PC diagnosis and a newly initiated outpatient prescription claim for pain medications from 2009-2018. Patients who were on pain medications before PC diagnosis, or of unspecified race/ethnicity were excluded from the analysis. We assessed three separate classes of pain medications including opioids, non-opioid analgesics, and neuropathic analgesics. Prescription claims were specific to patients diagnosed with PC and stratified by self-identified race/ethnicity. Our objective was to characterize the relationship between race and receipt of pain medications in the first year following the diagnosis of PC. Results: After application of the inclusion/exclusion criteria, 71,700 patients with PC were identified and included in the analysis (White: 80.3%; Black/African American: 11.8%; Asian/Pacific Islander: 4.5%; Hispanic: 3.1%; Native American 0.25%). As compared to White patients, Black/African American (Relative Risk [RR] 0.97; 95% Confidence Interval [CI]: 0.96-0.99) and Asian/Pacific Islander patients (RR 0.88; 95% CI: 0.85-0.90) were less likely to be prescribed an opioid analgesic. Black/African American (RR 1.09; 95% CI: 1.02-1.16), Asian/Pacific Islander (RR 1.52; 95% CI: 1.41-1.65), and Hispanic (RR 1.45; 95% CI: 1.31-1.59) patients were more likely to be prescribed a non-opioid analgesic. Black/African American (RR: 1.11; 95% CI: 1.05-1.18) patients were more likely to be prescribed a neuropathic analgesic. No other differences were noted in pain medication use by race/ethnicity. Conclusion: Our study findings suggest that pain medication usage in patients with PC varies for racial/ethnic minorities as compared to White patients, in particular for Black/African Americans. Future research should explore the impact of sociocultural, and psychosocial factors on pain medication usage patterns in racial/ethnic minority patients with PC.

Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana J. Wilkie. Disparities in the use of pain medication in patients with pancreatic cancer: Focus on racial and ethnic minorities [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A026.