Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA.
Cancer Med. 2023 May;12(9):10851-10864. doi: 10.1002/cam4.5755. Epub 2023 Mar 14.
We examined whether there are racial disparities in pain management, opioid medicine prescriptions, symptom severity, and quality of life constructs in breast cancer survivors.
We conducted a secondary analysis of longitudinal data from the Women's Hormonal Therapy Initiation and Persistence (WHIP) study (n = 595), a longitudinal study of hormonal receptor-positive breast cancer survivors. Upon study enrollment, patients completed a survey assessing an array of psychological, behavioral, and treatment outcomes, including adjuvant endocrine therapy (AET)-induced symptoms, and provided a saliva biospecimen. Opioid prescription records were extracted from the health maintenance organizations (HMOs) pharmacy database. The final analytic sample included women with complete HMO pharmacy records for 1 year.
There were 251 eligible patients, of which 169 (67.3%) were White. The average age was 61.09 years old (SD = 11.07). One hundred seventy-two patients (68.5%) had received at least one opioid medication and 37.1% were prescribed opioids longer than 90 days (n = 93). Sixty-four Black patients (78%) had a record of being prescribed with opioids compared to 64% of White patients (n = 108, p = 0.03). Black patients reported worse vasomotor, neuropsychological, and gastrointestinal symptoms, as well as lower quality of life and greater healthcare discrimination than White patients (p's < 0.05). Black patients were more likely to be prescribed opioids for 90 days or longer compared to White patients, when controlling for age, marital status, income, body mass index (BMI), cancer stage, and chemotherapy status (adjusted Odds Ratio = 2.72, p = 0.014).
Findings indicate that there are racial differences in opioid prescriptions supplied for pain management and symptomatic outcomes. Future research is needed to understand the causes of disparities in cancer pain management and symptomatic outcomes.
我们研究了在乳腺癌幸存者中，疼痛管理、阿片类药物处方、症状严重程度和生活质量结构方面是否存在种族差异。
我们对激素受体阳性乳腺癌幸存者的纵向研究“女性激素治疗启动和持续研究（WHIP）”的纵向数据进行了二次分析（n=595）。在研究入组时，患者完成了一项调查，评估了一系列心理、行为和治疗结果，包括辅助内分泌治疗（AET）引起的症状，并提供了唾液生物样本。阿片类药物处方记录是从健康维护组织（HMO）的药房数据库中提取的。最终分析样本包括 HMO 药房记录完整的 1 年的女性。
有 251 名符合条件的患者，其中 169 名（67.3%）为白人。平均年龄为 61.09 岁（SD=11.07）。172 名患者（68.5%）至少接受过一种阿片类药物治疗，37.1%的患者服用阿片类药物的时间超过 90 天（n=93）。64 名黑人患者（78%）有服用阿片类药物的记录，而 64%的白人患者（n=108，p=0.03）有服用阿片类药物的记录。与白人患者相比，黑人患者报告的血管舒缩、神经心理和胃肠道症状更严重，生活质量更低，医疗保健歧视更多（p<0.05）。在控制年龄、婚姻状况、收入、体重指数（BMI）、癌症分期和化疗状态后，与白人患者相比，黑人患者更有可能被开处 90 天或更长时间的阿片类药物（调整后的优势比=2.72，p=0.014）。
研究结果表明，在阿片类药物处方用于疼痛管理和症状结果方面存在种族差异。需要进一步研究以了解癌症疼痛管理和症状结果差异的原因。
