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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Article info
Publication history
Published online: June 13, 2015
Accepted:
May 28,
2015
Received in revised form:
May 23,
2015
Received:
January 20,
2015
Footnotes
Supported by NIH Challenge Grant to S.H.M. (NIH/NINR RC1-NR011591).
No authors declared any financial or nonfinancial conflicts of interest.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
