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Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device

  • Salimah H. Meghani
    Correspondence
    Address reprint requests to Salimah H. Meghani, PhD, MBE, RN, FAAN, Associate Professor, Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions & Health, University of Pennsylvania, School of Nursing, Associate Fellow, Center for Bioethics, Claire M. Fagin Hall, 418 Curie Boulevard, Room 337, Philadelphia, PA 19104-4217.
    Affiliations
    Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania

    NewCourtland Center of Transitions and Health, Philadelphia, Pennsylvania

    Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Aleda M.L. Thompson
    Affiliations
    Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Jesse Chittams
    Affiliations
    Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Deborah W. Bruner
    Affiliations
    Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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  • Barbara Riegel
    Affiliations
    Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania

    NewCourtland Center of Transitions and Health, Philadelphia, Pennsylvania
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      Highlights

      • There is evidence of stark disparities in cancer pain outcomes among African Americans (AAs).
      • Differential analgesic adherence may be an important explanatory variable in these disparities.
      • We objectively assessed adherence to prescribed analgesics for cancer pain among AAs and whites.
      • Both magnitude and predictors of adherence varied by race indicating unique intervention targets for AA and whites.
      • Commonly implicated fears (eg, addiction concerns) did not explain adherence in both groups.
      • EP presents a biology of pain that underpins a biopsychosocial approach.

      Abstract

      Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and whites using the Medication Event Monitoring System (MEMS). Patients (N = 207) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia (≥18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least 1 prescription of oral around-the-clock analgesic). African Americans reported significantly greater cancer pain (P < .001), were less likely than whites to have a prescription of long-acting opioids (P < .001), and were more likely to have a negative Pain Management Index (P < .001). There were considerable differences between African Americans and whites in the overall MEMS dose adherence, ie, percentage of the total number of prescribed doses that were taken (53% vs 74%, P < .001). On subanalysis, analgesic adherence rates for African Americans ranged from 34% (for weak opioids) to 63% (for long-acting opioids). Unique predictors of analgesic adherence varied by race; income levels, analgesic side effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for whites.

      Perspective

      Despite evidence of disparities in cancer pain outcomes among African Americans, surprisingly little research exists on African Americans' adherence to analgesia for cancer pain. This prospective study uses objective measures to compare adherence to prescribed pain medications between African American and white patients with cancer pain.

      Key words

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      References

        • Anderson K.O.
        • Green C.R.
        • Payne R.
        Racial and ethnic disparities in pain: causes and consequences of unequal care.
        J Pain. 2009; 10: 1187-1204
        • Anderson K.O.
        • Mendoza T.R.
        • Payne R.
        • Valero V.
        • Palos G.R.
        • Nazario A.
        • Richman S.P.
        • Hurley J.
        • Gning I.
        • Lynch G.R.
        • Kalish D.
        • Cleeland C.S.
        Pain education for underserved minority cancer patients: a randomized controlled trial.
        J Clin Oncol. 2004; 22: 4918-4925
        • Arnsten J.H.
        • Demas P.A.
        • Farzadegan H.
        • Grant R.W.
        • Gourevitch M.N.
        • Chang C.J.
        • Buono D.
        • Eckholdt H.
        • Howard A.A.
        • Schoenbaum E.E.
        Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring.
        Clin Infect Dis. 2001; 33: 1417-1423
        • Bardia A.
        • Barton D.L.
        • Prokop L.J.
        • Bauer B.A.
        • Moynihan T.J.
        Efficacy of complementary and alternative medicine therapies in relieving cancer pain: a systematic review.
        J Clin Oncol. 2006; 24: 5457-5464
        • Bennett M.I.
        • Bagnall A.M.
        • Jose Closs S.
        How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis.
        Pain. 2009; 143: 192-199
        • Choo P.W.
        • Rand C.S.
        • Inui T.S.
        • Lee M.L.
        • Cain E.
        • Cordeiro-Breault M.
        • Canning C.
        • Platt R.
        Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy.
        Med Care. 1999; 37: 846-857
        • Chung K.F.
        • Naya I.
        Compliance with an oral asthma medication: a pilot study using an electronic monitoring device.
        Respir Med. 2000; 94: 852-858
        • Cintron A.
        • Morrison R.S.
        Pain and ethnicity in the United States: a systematic review.
        J Palliat Med. 2006; 9: 1454-1473
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: global use of the brief pain inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Daniels T.
        • Goodacre L.
        • Sutton C.
        • Pollard K.
        • Conway S.
        • Peckham D.
        Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers.
        Chest. 2011; 140: 425-432
        • Ezenwa M.O.
        • Ameringer S.
        • Ward S.E.
        • Serlin R.C.
        Racial and ethnic disparities in pain management in the United States.
        J Nurs Scholarsh. 2006; 38: 225-233
        • Green C.R.
        • Anderson K.O.
        • Baker T.A.
        • Campbell L.C.
        • Decker S.
        • Fillingim R.B.
        • Kalauokalani D.A.
        • Lasch K.E.
        • Myers C.
        • Tait R.C.
        • Todd K.H.
        • Vallerand A.H.
        The unequal burden of pain: confronting racial and ethnic disparities in pain.
        Pain Med. 2003; 4: 277-294
        • Green C.R.
        • Ndao-Brumblay S.K.
        • West B.
        • Washington T.
        Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan.
        J Pain. 2005; 6: 689-699
        • Hamilton G.A.
        Measuring adherence in a hypertension clinical trial.
        Eur J Cardiovasc Nurs. 2003; 2: 219-228
        • Heisler M.
        • Wagner T.H.
        • Piette J.D.
        Patient strategies to cope with high prescription medication costs: who is cutting back on necessities, increasing debt, or underusing medications?.
        J Behav Med. 2005; 28: 43-51
        • Institute of Medicine
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
        National Academies Press, Washington, D.C2011
        • Kravitz R.L.
        • Tancredi D.J.
        • Grennan T.
        • Kalauokalani D.
        • Street Jr., R.L.
        • Slee C.K.
        • Wun T.
        • Oliver J.W.
        • Lorig K.
        • Franks P.
        Cancer health empowerment for living without pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment.
        Pain. 2011; 152: 1572-1582
        • Kurlander J.E.
        • Kerr E.A.
        • Krein S.
        • Heisler M.
        • Piette J.D.
        Cost-related nonadherence to medications among patients with diabetes and chronic pain: factors beyond finances.
        Diabetes Care. 2009; 32: 2143-2148
        • LaFleur J.
        • Oderda G.M.
        Methods to measure patient compliance with medication regimens.
        J Pain Palliat Care Pharmacother. 2004; 18: 81-87
        • Lu W.
        • Rosenthal D.S.
        Acupuncture for cancer pain and related symptoms.
        Curr Pain Headache Rep. 2013; 17: 321
        • Meghani S.H.
        Corporatization of pain medicine: implications for widening pain care disparities.
        Pain Med. 2011; 12: 634-644
        • Meghani S.H.
        • Bruner D.W.
        A pilot study to identify correlates of intentional versus unintentional nonadherence to analgesic treatment for cancer pain.
        Pain Manag Nurs. 2013; 14: e22-e30
        • Meghani S.H.
        • Byun E.
        • Gallagher R.M.
        Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States.
        Pain Med. 2012; 13: 150-174
        • Meghani S.H.
        • Chittams J.
        • Hanlon A.L.
        • Curry J.
        Measuring preferences for analgesic treatment for cancer pain: how do African-Americans and whites perform on choice-based conjoint (CBC) analysis experiments?.
        BMC Med Inform Decis Mak. 2013; 13: 11
        • Meghani S.H.
        • Kang Y.
        • Chittams J.
        • McMenamin E.
        • Mao J.J.
        • Fudin J.
        African Americans with cancer pain are more likely to receive an analgesic with toxic metabolite despite clinical risks: a mediation analysis study.
        J Clin Oncol. 2014; 32: 2773-2779
        • Meghani S.H.
        • Polomano R.C.
        • Tait R.C.
        • Vallerand A.H.
        • Anderson K.O.
        • Gallagher R.M.
        Advancing a national agenda to eliminate disparities in pain care: directions for health policy, education, practice, and research.
        Pain Med. 2012; 13: 5-28
        • Miaskowski C.
        • Dodd M.
        • West C.
        • Schumacher K.
        • Paul S.M.
        • Tripathy D.
        • Koo P.
        Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management.
        J Clin Oncol. 2004; 22: 1713-1720
        • Miaskowski C.
        • Dodd M.J.
        • West C.
        • Paul S.M.
        • Tripathy D.
        • Koo P.
        • Schumacher K.
        Lack of adherence with the analgesic regimen: a significant barrier to effective cancer pain management.
        J Clin Oncol. 2001; 19: 4275-4279
        • Morisky D.E.
        • Green L.W.
        • Levine D.M.
        Concurrent and predictive validity of a self-reported measure of medication adherence.
        Med Care. 1986; 24: 67-74
        • Morrison R.S.
        • Wallenstein S.
        • Natale D.K.
        • Senzel R.S.
        • Huang L.L.
        “We don't carry that”–failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics.
        N Engl J Med. 2000; 342: 1023-1026
      1. National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive. Accessed October 6, 2014

        • Nguyen L.M.
        • Rhondali W.
        • De la Cruz M.
        • Hui D.
        • Palmer L.
        • Kang D.H.
        • Parsons H.A.
        • Bruera E.
        Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer.
        J Pain Symptom Manage. 2013; 45: 506-516
        • Oldenmenger W.H.
        To Be in Pain or Not: Research To Improve Cancer-Related Pain Management.
        Erasmus University Rotterdam, Rotterdam, The Netherlands2011
        • Oldenmenger W.H.
        • Echteld M.A.
        • de Wit R.
        • Sillevis Smitt P.A.
        • Stronks D.L.
        • Stoter G.
        • van der Rijt C.C.
        Analgesic adherence measurement in cancer patients: comparison between electronic monitoring and diary.
        J Pain Symptom Manage. 2007; 34: 639-647
        • Oldenmenger W.H.
        • Sillevis Smitt P.A.
        • van Dooren S.
        • Stoter G.
        • van der Rijt C.C.
        A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal.
        Eur J Cancer. 2009; 45: 1370-1380
        • Osterberg L.
        • Blaschke T.
        Adherence to medication.
        N Engl J Med. 2005; 353: 487-497
        • Piette J.D.
        • Heisler M.
        • Wagner T.H.
        Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk.
        Am J Public Health. 2004; 94: 1782-1787
        • Piette J.D.
        • Heisler M.
        • Wagner T.H.
        Cost-related medication underuse: do patients with chronic illnesses tell their doctors?.
        Arch Intern Med. 2004; 164: 1749-1755
        • Rhee Y.O.
        • Kim E.
        • Kim B.
        Assessment of pain and analgesic use in African American cancer patients: factors related to adherence to analgesics.
        J Immigr Minor Health. 2012; 14: 1045-1051
        • Rustoen T.
        • Valeberg B.T.
        • Kolstad E.
        • Wist E.
        • Paul S.
        • Miaskowski C.
        The Pro-Self(c) pain control program improves patients' knowledge of cancer pain management.
        J Pain Symptom Manage. 2012; 44: 321-330
        • SAS Institute Inc
        SASÆ Component Language 9.3.
        SAS Institute, Cary, NC2011
        • Smedley B.D.
        • Stith A.Y.
        • Nelson A.R.
        Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
        The National Academies Press, Washington, DC2003
        • Street Jr., R.L.
        • Tancredi D.J.
        • Slee C.
        • Kalauokalani D.K.
        • Dean D.E.
        • Franks P.
        • Kravitz R.L.
        A pathway linking patient participation in cancer consultations to pain control.
        Psychooncology. 2014; 23: 1111-1117
        • Syrjala K.L.
        • Abrams J.R.
        • Polissar N.L.
        • Hansberry J.
        • Robison J.
        • DuPen S.
        • Stillman M.
        • Fredrickson M.
        • Rivkin S.
        • Feldman E.
        • Gralow J.
        • Rieke J.W.
        • Raish R.J.
        • Lee D.J.
        • Cleeland C.S.
        • DuPen A.
        Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial.
        Pain. 2008; 135: 175-186
        • Valeberg B.T.
        • Miaskowski C.
        • Hanestad B.R.
        • Bjordal K.
        • Moum T.
        • Rustoen T.
        Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications.
        Clin J Pain. 2008; 24: 627-636
        • Wagner G.J.
        • Ghosh-Dastidar B.
        Electronic monitoring: adherence assessment or intervention?.
        HIV Clin Trials. 2002; 3: 45-51
        • Wagner T.H.
        • Heisler M.
        • Piette J.D.
        Prescription drug co-payments and cost-related medication underuse.
        Health Econ Policy Law. 2008; 3: 51-67
        • Ward S.
        • Donovan H.S.
        • Owen B.
        • Grosen E.
        • Serlin R.
        An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers.
        Res Nurs Health. 2000; 23: 393-405
        • Ward S.E.
        • Carlson-Dakes K.
        • Hughes S.H.
        • Kwekkeboom K.L.
        • Donovan H.S.
        The impact on quality of life of patient-related barriers to pain management.
        Res Nurs Health. 1998; 21: 405-413
        • Ward S.E.
        • Goldberg N.
        • Miller-McCauley V.
        • Mueller C.
        • Nolan A.
        • Pawlik-Plank D.
        • Robbins A.
        • Stormoen D.
        • Weissman D.E.
        Patient-related barriers to management of cancer pain.
        Pain. 1993; 52: 319-324
        • Wieder R.
        • Delarosa N.
        • Bryan M.
        • Hill A.M.
        • Amadio W.J.
        Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain.
        Pain Med. 2014; 15: 42-51
        • World Health Organization
        Cancer Pain Relief.
        Switzerland, Geneva1986
        • World Health Organization
        Cancer Pain Relief and Palliative Care.
        Switzerland, Geneva1996
        • Yoong J.
        • Traeger L.N.
        • Gallagher E.R.
        • Pirl W.F.
        • Greer J.A.
        • Temel J.S.
        A pilot study to investigate adherence to long-acting opioids among patients with advanced lung cancer.
        J Palliat Med. 2013; 16: 391-396
        • Zeller A.
        • Ramseier E.
        • Teagtmeyer A.
        • Battegay E.
        Patients' self-reported adherence to cardiovascular medication using electronic monitors as comparators.
        Hypertens Res. 2008; 31: 2037-2043
        • Zhukovsky D.S.
        • Gorowski E.
        • Hausdorff J.
        • Napolitano B.
        • Lesser M.
        Unmet analgesic needs in cancer patients.
        J Pain Symptom Manage. 1995; 10: 113-119