Department of Radiation Oncology, Stanford University, Stanford, CA.
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.
JCO Oncol Pract. 2021 Jun;17(6):e703-e713. doi: 10.1200/OP.20.00773. Epub 2021 Feb 3.
Minority race and lower socioeconomic status are associated with lower rates of opioid prescription and undertreatment of pain in multiple noncancer healthcare settings. It is not known whether these differences in opioid prescribing exist among patients undergoing cancer treatment.
This observational cohort study involved 33,872 opioid-naive patients of age > 65 years undergoing definitive cancer treatment. We compared rates of new opioid prescriptions by race or ethnicity and socioeconomic status controlling for differences in baseline patient, cancer, and treatment factors. To evaluate downstream impacts of opioid prescribing and pain management, we also compared rates of persistent opioid use and pain-related emergency department (ED) visits.
Compared with non-Hispanic White patients, the covariate-adjusted odds of receiving an opioid prescription were 24.9% (95% CI, 16.0 to 33.9, < .001) lower for non-Hispanic Blacks, 115.0% (84.7 to 150.3, < .001) higher for Asian-Pacific Islanders, and not statistically different for Hispanics (-1.0 to 14.0, = .06). There was no significant association between race or ethnicity and persistent opioid use or pain-related ED visits. Patients living in a high-poverty area had higher odds (53.9% [25.4 to 88.8, < .001]) of developing persistent use and having a pain-related ED visit (39.4% [16.4 to 66.9, < .001]).
For older patients with cancer, rates of opioid prescriptions and pain-related outcomes significantly differed by race and area-level poverty. Non-Hispanic Black patients were associated with a significantly decreased likelihood of receiving an opioid prescription. Patients from high-poverty areas were more likely to develop persistent opioid use and have a pain-related ED visit.
在多个非癌症医疗保健环境中，少数族裔和较低的社会经济地位与阿片类药物处方率较低和疼痛治疗不足有关。尚不清楚在接受癌症治疗的患者中是否存在阿片类药物处方的这些差异。
本观察性队列研究纳入了 33872 名年龄>65 岁、接受确定性癌症治疗的阿片类药物初治患者。我们比较了按种族或族裔以及社会经济地位划分的新阿片类药物处方率，同时控制了基线患者、癌症和治疗因素的差异。为了评估阿片类药物处方和疼痛管理的下游影响，我们还比较了持续使用阿片类药物和与疼痛相关的急诊就诊率。
与非西班牙裔白人患者相比，调整协变量后，接受阿片类药物处方的几率分别为非西班牙裔黑人患者低 24.9%（95%CI，16.0 至 33.9，<0.001），亚裔-太平洋岛民患者高 115.0%（84.7 至 150.3，<0.001），西班牙裔患者无显著差异（-1.0 至 14.0，=0.06）。种族或族裔与持续使用阿片类药物或与疼痛相关的急诊就诊之间没有显著关联。居住在高贫困地区的患者发生持续使用和与疼痛相关的急诊就诊的几率更高（持续使用的几率为 53.9%（25.4 至 88.8，<0.001），与疼痛相关的急诊就诊的几率为 39.4%（16.4 至 66.9，<0.001））。
对于患有癌症的老年患者，阿片类药物处方率和疼痛相关结局因种族和地区贫困程度而显著不同。非西班牙裔黑人患者接受阿片类药物处方的可能性显著降低。来自高贫困地区的患者更有可能持续使用阿片类药物并发生与疼痛相关的急诊就诊。
