Data Show Non-White Patients With Advanced GI Cancer Less Likely to Use Opioids at EOL

By FYH News Team

Published on October 26, 2023

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Racial and ethnic disparities in access to opioids near the end of life (EOL) were observed among patients with gastrointestinal cancers, according to study results published in the Annals of Surgical Oncology.

Opioid regulations aimed at reducing access due to the opioid epidemic have inadvertently led to reduced access for patients near EOL. The aim of this study was to evaluate whether race and ethnicity contributed to disparities in access to opioids near EOL.

Data for this study were sourced from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. A total of 48,631 patients with advanced gastrointestinal cancer who died between 2008 and 2016 were evaluated for opioid use in the 30 days before death or hospice enrollment.

The patients were median 77.0 years (IQR, 71.0-83.0) at diagnosis, 53.1% were women, 66.6% were White, 12.1% were Hispanic, 11.5% were Black, 6.4% were Asian, and 3.5% were other races or ethnicities. All baseline characteristics differed between race and ethnicity groups (all, P <.001).

After adjusting for cofounders, Hispanic (adjusted odds ratio [aOR], 0.90), Black (aOR, 0.84), Asian (aOR, 0.86), and other (aOR, 0.83) racial and ethnic groups were less likely to fill 1 or more opioid prescriptions near EOL compared with White patients (all, P <.05).

Among opioid users, Hispanic (−19.1%), Black (−16.5%), and Asian (−11.9%) patients received lower daily doses than White patients (all, P <.05).

Additional significant covariates of opioid use and dosage included age, cancer diagnosis, tumor grade, dual Medicaid/Medicare eligibility status, and poverty duration.

These trends may have been biased, as prescription fills were used as a proxy for opioid consumption.

“These data serve to highlight race/ethnicity-based disparities in EOL care, as well as how [social determinants of health] differentially impact patient populations relative to opioid pain management,” the study authors concluded.

Reference

Munir MM, Woldesenbet S, Endo Y, et al. Association of race/ethnicity, persistent poverty, and opioid access among patients with gastrointestinal cancer near the end of life. Ann Surg Oncol. Published online September 4, 2023. doi:10.1245/s10434-023-14218-4

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