Abstract C005: Racial differences in painful body surface area (bSA) and pain intensity among hospice cancer patients
Authors: Marshall Tanaia , Keesha Roach , Singh Prashant , Yao Yingwei , Wilkie Diana 
Published: September 2020

Abstract
Introduction: Although pain is subjective and highly variable between individuals, little is known about the amount of body surface area (BSA) that represents chronically painful locations reported by patients with cancer. The purpose of this study was to explore associations between BSA and demographic, cancer, and other pain variables. Methodology: We used baseline data from a five-step, stepped-wedge randomized clinical trial of cancer patients receiving hospice care. Participants were 259 hospice patients (51% female; mean age 68.4±14.2; 34% Black, 50% White, 14% Other race; 18% Hispanic) who completed PAINReportIt, a measure of pain as a multi-dimensional phenomenon. This computerized software design allowed patients to (a) draw on front and back body outlines where they had pain, (b) select numbers from 0-10 to report their current, least and worst pain intensity in the past 24 hours, and (c) indicate their age, gender, race, ethnicity and type of cancer. We used a novel algorithm with the ImageJ software to calculate the BSA from the digital pain drawings and the R statistical program to conduct descriptive, correlational, and ANOVA analyses. Results: The other race group included 2 Asians, 35 Hispanics and 5 non-Hispanic Other. The three largest painful BSAs for a body region were located in the abdomen (12.0%±18.8%), lower back (6.8%±12.6%), and upper back (4.2%±9.3%). Patients’ average pain intensity scores were: Now (4.7±2.6), Least (3.2±2.4) and Worst (7.0±2.4). Differences by race were noted for the total BSA (p=.03), pain now (p=.02), and pain worst (p=.03). Blacks reported the lowest total BSA, Whites the lowest pain now and worst pain, and the Other racial group the highest total BSA, pain now and pain worst. With Bonferroni adjustment, Other and Black differed on BSA (p=.02) and Other and White differed on pain now (p=.05). Total BSA was significantly correlated with pain now (r=.17, p=.01), pain least (r=.15, p=.02), pain worst (r=.24, p&lt;.001), and the number of sites (r=.31, p&lt;.001). Total BSA was not significantly associated with type of cancer, but regions with highest total BSA were consistent with primary cancer site. Conclusion: Our sample included a large number of patients from minority groups. Based on known disparities in pain control between Blacks and Whites, our findings are surprising. Findings may reflect culturally competent care that still requires greater attention to reduce the severity of worst pain. Reasons for differences in pain dimensions by racial groups and not for the type of cancer are unclear from our initial study of BSA among patients receiving hospice care. In the future, studies are needed to understand these differences and explore if other pain dimensions like pain quality and pain pattern differ by race and ethnicity, since individuals identifying as Hispanic had the highest BSA and pain intensity.
Citation Format: Tanaia Marshall, Roach Keesha, Prashant Singh, Yingwei Yao, Diana Wilkie. Racial differences in painful body surface area (bSA) and pain intensity among hospice cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C005.