Cancer-related Pain Experience Differs by Race, Ethnicity

With the co-occurrence of chronic pain and cancer amassing from improved cancer survival rates, it is increasingly important for healthcare professionals to understand how the conditions interrelate and influence patients’ quality of life.

To offer an explanation on the correlation among patient demographics, cancer experience, pain status, and life satisfaction, Carmen R. Green, MD, and Tamera A. Hart-Johnson, MS, of the Office for Health Equity and Inclusion at the University of Michigan Medical School in Ann Arbor, MI, extracted related data from a sample of 25,010 older adults and presented their findings in a research poster at the American Pain Society 33rd Annual Scientific Meeting, held April 30, 2014, to May 3, 2014, in Tampa, FL.

According to the poster authors, “cancer-related chronic pain, or pain lasting >6 months specifically related to cancer or treatment, is experienced by as many as 20% of survivors at any given time and 43% at some point after diagnosis, and disparities in severity, prevalence, and treatment of pain have been found by race and gender.” Despite those staggering statistics, “pain in cancer survivors has not been looked at in a large, nationally representative sample, though it is hypothesized the rates and impact would be similar to those found in smaller studies,” they noted.

Pulling 2010 data from the longitudinal Health and Retirement Study (HRS) of Americans aged >50 years, Green and Hart-Johnson examined patient self-reports on age, race, gender, cancer diagnosis, pain level, general health, and satisfaction with their home, city, leisure, family, finances, household income, health, and life.

Within the large sample of older patients, 15% were black, 9% were Latino, and 60% were female, although the researchers noted “women were more overrepresented among black participants than white or Latino.” While black and Latino participants had lower cancer prevalence compared to their white counterparts, they reported a greater incidence of cancer-related pain. So, as Green and Hart-Johnson explained, “If they have cancer, they are more likely to have related pain.”

Although pain was linked to lower satisfaction across all of the demographic groups, the poster authors said “there were interactions showing a greater negative effect for black (Americans) than others.” Thus, they determined “black race, cancer, and pain are all associated with poorer satisfaction in a variety of domains.”

After breaking down the patient satisfaction measures based on pain and cancer status, Green and Hart-Johnson found that “pain more often had a negative impact on satisfaction outcomes, and people with pain looked more similar on satisfaction regardless of cancer status.” In response to that finding, the co-authors reiterated that “cancer pain needs to be adequately treated.”

“In the absence of pain, people with cancer may have a greater appreciation for their surroundings and life. People with cancer but no pain, in fact, were, in some cases, the most satisfied,” the investigators concluded. “But pain has a detrimental effect for all, with a greater impact for black Americans.”

Green and Hart-Johnson added that the overrepresentation of cancer-related pain among black and Latino patients “highlight(s) the importance of pain evaluation in all cancer patients, but particularly in these 2 groups.”