2A-03 - National Utilization of Pain Treatments among U.S. Cancer Survivors from 2011 through 2020

Background: Pain is one of the most prevalent symptoms of the 18 million cancer survivors living in the United States (U.S.). It is unclear how the U.S. opioid epidemic influenced the use of prescription opioids, non-opioid alternatives, and multi-modal multidisciplinary treatments (e.g., pharmacologic and adjuvant nonpharmacologic therapies) among this population.

Objectives: We described annual trends in pain treatment use among U.S. cancer survivors from 2011 through 2020. We assessed whether annual trends varied according to policy-actionable social determinants of health such as education, income, race and ethnicity, and geography.

Methods: We conducted a serial cross-sectional analysis of the Medical Expenditure Panel Survey from January 2011 to December 2020, including non-institutionalized U.S. adults with diagnosed pain and primary cancer, secondary malignancies. The primary exposure was calendar year. The primary outcome was four mutually exclusive pharmacy-verified pain treatments: (1) opioids only, (2) nonpharmacologic treatments only, (3) both opioid and nonpharmacologic treatments (i.e., multimodal multidisciplinary treatment), and (4) neither opioids nor nonpharmacologic treatment. Covariates included demographic factors, health status and cancer type, and non-opioid pain medications. We used weighted prevalences to estimate annual utilization, stratified by income, education, race/ethnicity, and geography. We used binary logistic regression models to calculate adjusted estimates.

Results: In our sample (N=41,064,668) most adults were ≥65 years of age (67%), female (52%), and White (91%). Compared to 2011, multimodal treatments increased from 4% [95% confidence interval (CI), 2%-6%] to 10% (6%-14%) in 2019 while using neither pain treatment decreased from 62% (55%-68%) to 46% (40%-52%). After covariate adjustment, compared to 2011, the odds of using multimodal treatments increased in 2019 [odds ratio (OR), 2.8; 95% CI, 1.4-5.2] and 2020 (OR, 2.5; [1.1-5.3]), while the odds of using neither treatment decreased in both years (2019: OR, 0.5; [95% CI, 0.3-0.7]; 2020: OR, 0.5; [0.3-0.8]) versus 2011. These estimates varied according to education, income, race/ethnicity, and geographic residence. The use of gabapentinoids (10.7%), NSAIDs (11.8%), SNRIs (2.1%), and SSRIs (0.5%) for pain were relatively uncommon and varied little between mutually exclusive pain treatment groups.

Conclusions: Compared to 2011, fewer cancer survivors used neither opioid nor nonpharmacologic treatments in recent years, owing to an increase in multimodal treatments. Disparities in pain treatment use remain for those with low income or education and racial or ethnic minorities.