Sociodemographic differences in patient-reported pain and pain management of head and neck cancer patients in a community oncology setting.
Osazuwa-Peters, N; Larsen, R; Patel, A; Misra, S; Pearson, B; Smith, B; Canick, J; Kuziez, D; Rohde, RL
Published in: Journal of Clinical Oncology
150 Background: There are currently 500,000 head and neck cancer (HNC) survivors in the United States. Pain is common among survivors and associated with adverse quality of life and outcomes. There is however a lack of data on pain management in the community oncology setting, where a growing number of patients may be receiving long-term care. We described sociodemographic correlates of patient-reported pain among HNC patients receiving care in the community setting. Methods: We used data from Navigating Cancer, a nationwide, community-oncology, patient-reported outcomes database that include electronic patient-reported outcomes (ePROs) from 253 cancer clinics and over 1 million cancer survivors. We identified a retrospective cohort of patients diagnosed with HNC after January 1, 2017, with at least one record of patient-reported pain through nurse triage. We characterized demographic and clinical factors associated with any reported pain, and pain resolution by new pain prescription, based on race (white vs. non-white patients), and other sociodemographic characteristics. Results: Our cohort included 3,762 patients, 62.8% white, 45.3% married, with an average age of 66.0 years. Of these, 652 patients (17%) reported at least one pain event during study period. After adjusting for covariates, there was no statistically significant difference in the odds of any reported pain between white vs. non-white patients (aOR = 0.81; 95% CI 0.57, 1.15). However, we found that white HNC patients were significantly more likely to be provided a new prescription for pain management more than non-white patients, (aOR = 4.58; 95% CI 2.23, 9.38). Other factors associated with prescription of new pain prescription included being single/unpartnered (aOR = 1.34; 95% CI 1.03, 1.75) compared to being married/partnered, having Medicare (aOR = 3.07; 95% CI 1.59, 5.93) or commercial insurance (aOR = 2.88; 95% CI 1.54, 5.38) compared to Medicaid. Additionally, male patients were significantly less likely to receive new prescription compared to females (aOR = 0.48; 95% CI 0.37, 0.61). Conclusions: One-in-six HNC patients in the community oncology setting reported pain, and while there were no racial differences in any pain report, white patients were significantly more likely to receive new pain prescription, as were those with Medicare or commercial insurance. There may be disparity in the management of reported pain among HNC survivors based on race.
