Quality of pain management in patients with cancer in the outpatient setting.

person Biplov Adhikari MedStar Union Memorial Hospital, Baltimore, MD info_outline Biplov Adhikari, Nistha Shrestha, Smriti Maskey, Vijaya Raj Bhatt

Authors person Biplov Adhikari MedStar Union Memorial Hospital, Baltimore, MD info_outline Biplov Adhikari, Nistha Shrestha, Smriti Maskey, Vijaya Raj Bhatt Organizations MedStar Union Memorial Hospital, Baltimore, MD, The Ohio State University, Columbus, OH, University of Louisville, Louisville, KY, University of Nebraska Medical Center, Omaha, NE Abstract Disclosures Research Funding No funding received None. Background: Pain represents a common health issue among patients with cancer. Uncontrolled pain significantly impairs the quality of life, resulting in increased healthcare utilization and costs. We examined the patterns of pain medication prescriptions among patients with cancer pain in the outpatient setting. Methods: We used the National Ambulatory Medical Care Survey (NAMCS), an annually administered survey designed to collect data regarding the use of ambulatory medical services from office-based physicians in the United States. We analyzed NAMCS data from 2005 to 2019 for all types of cancers visits. The primary outcome was prescription of pain medications among patients with cancer pain. We performed multivariate logistic regression to identify factors associated with opioid and non-opioid prescription among patients with cancer pain. Results: We captured a total of 520.8 million outpatient visits from 2005-2019. Breast cancer (18.7%) followed by cancer of the male genital tract (11.0%) represented the highest proportion of patient visits. 4.8% of cancer patients reported pain. Majority (60%) complaining of pain did not receive any pain medications. 14.9% received opioids and 25.1% received nonsteroidal anti-inflammatory drugs, acetaminophen, or adjuvant pain medications. The odds of receiving opioids were 3.4 times higher among 45-65 years vs patients over 75 years. African-Americans had 84% higher odds of receiving opioid prescription compared to white patients. The odds of receiving opioids were 61% lower for privately insured vs patients on Medicare. Patients visiting oncologic care had 2.1 times higher odds of receiving opioids compared to primary care (Table). Conclusions: This is one of the largest drug utilization studies among patients with cancer in outpatient setting, covering half a billion patient visits. A significant proportion of outpatients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. Within the limitation of this dataset, undertreatment of pain in outpatients with cancer remains a major unmet patient need. Factors associated with pain medication prescription among cancer patients with pain in settings. Covariates Opioid Odds Ratio (95% CI) p-value Non-opioid Odds Ratio (95% CI) p-value Age (vs 75+) 45-64 years 3.43 (1.82, 6.45) 0.0007 1.89 (1.16, 3.08) 0.0035 65-74 years 1.58 (0.94, 2.68) 0.3796 1.32 (0.90, 1.95) 0.5603 Female (vs Male) 1.15 (0.77, 1.74) 0.4947 0.71 (0.50, 1.00) 0.0528 Race (vs White)Black 1.84 (1.027 3.31) 0.0058 0.89 (0.50, 1.58) 0.3305 Payer (vs Medicare)Private insurance 0.39 (0.23, 0.68) 0.0002 0.85 (0.56, 1.30) 0.1465 Medicaid 1.45 (0.66, 3.19) 0.0228 1.12 (0.50, 2.49) 0.8636 Specialty (vs Primary care)Oncology 2.12 (1.08, 4.16) <.0001 0.68 (0.36, 1.25) 0.4053 Surgical care 0.12 (0.06, 0.22) <.0001 0.57 (0.37, 0.88) <.0001