Black and Hispanic Patients Get Fewer Opioids but More Toxicology Screening for Pain at End of Life
Opioids are the recommended treatment of choice for cancer pain at the end of life according to all major guidelines, but Black and Hispanic patients are 13% and 11% less likely than their White counterparts, respectively, to obtain prescription opioids for cancer-related pain at the end of life, researchers reported (https://doi.org/10.1200/jco.22.01413) in the Journal of Clinical Oncology.
The researchers looked at trends in opioid prescription strengths and fills within 30 days before death or beginning hospice for 318,549 non-Hispanic White (White), Black, and Hispanic patients who were older than age 65 and had poor-prognosis cancers in the Medicare system. They found that although only 32.7% of the patients filled an opioid prescription for their advanced cancer, Black and Hispanic patients were 13.2% and 11.0%, respectively, less likely to do so. And even fewer patients received long-acting opioid prescriptions, at 9.4%, 7.2%, and 6.3%, for all, Hispanic, and Black patients, respectively.
The disparities extended to dosages, too: On average, doses for Black and Hispanic patients were 10.5 and 9.1 morphine milligram equivalents lower per day and 210 and 179 lower in total, respectively. Finally, urine drug screening increased nearly tenfold for all patients, but the increase was highest among Black individuals.
“There are substantial and persistent racial and ethnic inequities in opioid access among older patients dying of cancer, which are not mediated by socioeconomic variables,” the authors concluded. They cited other studies suggesting that certain biases and inaccurate beliefs, such as the incorrect perception that Black patients are less sensitive to pain, may be to blame for the disparities in how physicians and medical students assess and treat pain.
“Being in pain, particularly at the end of life, is one of the hugest hurdles to having a good quality of life or a good quality of death,” the principal investigator said in an interview (https://www.cancer.gov/news-events/cancer-currents-blog/2023/disparities-opioids-cancer-pain-end-of-life). “It’s of the utmost importance that patients with terminal cancer have equitable access to opioids.”
Oncology nurses are in a pivotal position to improve cancer pain management—including speaking out against the biases and disparities that lead to inequality in care. Use ONS’s position statement on Cancer Pain Management (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/cancer-pain-management) and ONS Guidelines™ for Acute (https://www.ons.org/pep/acute-pain), Breakthrough (https://www.ons.org/pep/breakthrough-pain), Chronic (https://www.ons.org/pep/chronic-pain), and Refractory/Intractable Pain (https://www.ons.org/pep/refractoryintractable-pain) for the evidence to support your stance.