Cancer and breakthrough pain's impact on a diverse population

Abstract

Background. Although breakthrough pain (BTP; pain flares interrupting well-controlled baseline pain) is common among patients with cancer, its prevalence, characteristics, and impact on health-related quality of life (HRQOL) are poorly understood in ethnic minorities. Methods. This comparative study examines ethnic and gender differences in BTP characteristics and impact on HRQOL. Patients with stage III or IV cancer of the breast, prostate, colorectal, or lung, or stage II-IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 months, and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Results. Respondents (N = 96) were 75% white, 66% female with a mean age of 56 ± 10 years. All subjects experienced significant psychological distress, but there were no racial differences in depression prevalence. Minorities reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P ≤ 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04) as well as greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Although minorities reported more flare types (3.0 vs 1.8, P = 0.001), there were no significant ethnic differences in the duration, quality, or location of pain flares. Minorities consistently reported poorer outcomes on each HRQOL subscale (physical, role, emotional, cognitive, and social functioning) measured, although not statistically significant, as well as poorer QOL symptom control (P = 0.08) including lower dyspnea control (P = 0.002). Conclusions. Overall, minorities experienced greater consistent and breakthrough pain as well as poorer HRQOL. These data suggest further health care disparities in the cancer and pain experience for minorities. © 2009 American Academy of Pain Medicine.