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Cancer: Minorities Report More Pain

Minorities, Women Rate Higher Levels of Cancer Pain, but Reasons for Disparity Aren’t Clear
By
WebMD Health News
Reviewed by Louise Chang, MD

May 7, 2009 -- Blacks, Hispanics, and other minorities with advanced cancer reported having more uncontrolled pain associated with their disease than non-Hispanic whites in a newly reported study.

Ninety-six patients with advanced cancer were asked to score their pain from zero to 10 over a six-month period, with zero representing no pain and 10 representing the worst pain they could imagine.

Whites consistently scored their constant- and breakthrough pain lower than non-whites.

Women also reported higher levels of breakthrough pain than men did.

All the patients who took part in the study had access to medical care, so the reasons for ethnic and gender differences are not entirely clear, lead researcher Carmen R. Green, MD, of the University of Michigan Health System tells WebMD.

It may be that the non-white survey respondents simply perceived their pain differently. Minority patients may also have received less treatment for pain than did whites.

“We have many therapeutic modalities for the treatment of cancer pain, yet the majority of patients who are dying from the disease are under-treated,” Green says. “While this is a problem across the board, it may be a bigger problem for minority patients.”

Minorities and Cancer Pain

Cleveland Clinic oncologist Derek Raghavan, MD, tells WebMD that the study was too small, with far too few minority participants to allow for meaningful conclusions about differences in perceived or real cancer pain among whites and non-whites.

Thirty percent of the patients in the study were non-white, and 70% were white. Two-thirds (66%) were women.

“The study would have to be much larger and balanced for race, as well as gender, social class, and education to provide meaningful information,” he says.

Raghavan directs Cleveland Clinic’s Taussig Cancer Center and he co-chairs the American Society of Clinical Oncology’s (ASCO) Health Disparities Advisory Group.

“We know that access to supported services is consistently reduced for minorities, including access to pain management, “ he says.

Raghavan says culture may play a role in whether people are stoic or expressive about their pain.

“It may not be that their perception of pain is different, but that their culture allows them to talk about pain more easily,” he says.

Access to Care an Issue

Because there are far fewer pain specialists working in poor and medically underserved areas, Raghavan says it is likely that significant differences in cancer pain management do exist between ethnic groups.

Language and other communication barriers may also keep minority patients from achieving adequate pain relief, he says.

Last week, the ASCO group Raghavan co-chairs released policy recommendations targeting cancer care disparities among different racial, regional, and economic groups in the United States.

The ASCO effort will focus on increasing research into the quality of care provided to minority patients, increasing minority enrollment in clinical trials, increasing diversity in the field of oncology, and reducing economic barriers to cancer care.

At an April 28th news briefing, it was reported that cancer incidence among minorities living in the United States will double over the next two decades.

Raghavan called racial barriers to cancer care a national emergency.

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