Older Black and Hispanic Cancer Patients Less Apt to Receive Opioids During End of Life Care
Michelle Milliken
Due to the opioid crisis, prescriptions for opioids have fallen substantially in recent years. According to the U.S. Centers for Disease Control and Prevention, between 2012 and 2020, prescriptions per 100 people went from 81.3 to 43.3. This drop has even impacted those nearing the end of their terminal cancer journeys. However, a new study finds that there are racial disparities among who has received such a prescription at the end of life.
Researchers from the Dana-Farber Cancer Institute recently looked at the racial demographics of older cancer patients receiving opioid prescriptions over the last few weeks of their lives. This was in an effort to better understand how things may have changed as a result of the opioid crisis.
Dr. Andrea Enzinger, gastrointestinal oncologist and the study's lead author, says, "Most previous studies of inequities in cancer pain management were conducted before the full scope of the opioid crisis was recognized and regulations to curb opioid prescribing were put in place. Over the past decade, there has been a seismic shift in prescribing practices and sharp declines in access to these medications for patients with cancer. But we know very little about the current state of disparities in access in this environment of increased regulation, and about the magnitude of disparities among patients with terminal cancer."
When her team investigated, they found that older Black and Hispanic patients were less apt than white patients to get this pain relief at the end of their lives. They were also more apt to be screened for drugs.
To conduct the research, published in the Journal of Clinical Oncology, the team looked at prescription data from more than 300,000 Medicare patients over the age of 65 who had a poor cancer prognosis and were nearing the end of life. Overall, such patients saw a decline in prescriptions for opioids between 2007 and 2019, along with an uptick in urine tests for drugs. However, compared to white patients, Black patients were 4.3 percentage points less likely to receive any opioid and 3.2 percentage points less likely to receive a long-acting opioid. For Hispanic patients, those figures were 3.6 and 2.2 percentage points, respectively. If they did receive a prescription, both groups were also more likely to receive a lower dose than the average white patient. The researchers say these trends were true despite other factors like socioeconomic level.
The National Comprehensive Cancer Network suggests urine testing for drugs for patients on opioids, though there's no recommendation for how often screening should occur. The research team says with regard to this, there were also racial disparities uncovered by their study. Black patients, men in particular, were significantly more likely to undergo drug screening.
Dr. Alexi Wright, senior author and gynecologic oncologist, says, "The disparities in urine drug screening are modest but important, because they hint at underlying systematic racism in recommending patients for screening. Screening needs to either be applied uniformly or not at all for patients in this situation."
This is one of many recent studies highlighting disparities in cancer care. Others have found that American Indian and Alaska Native women are more apt to get mastectomies for early stage cancers and Native Hawaiians and Pacific Islanders have worse breast cancer outcomes.
