Opioid Medication Access during Palliative Radiation Therapy

Abstract

Pain management is a primary goal of care for patients receiving palliative radiotherapy. Historically, minority populations have had less access to proper pain management regimens; it is important to examine whether there are disparities in the setting of palliative radiation pain management. The purpose of this study is to examine the impact of treatment location, minority status, Spanish language preference, and socioeconomic status on access to opioid medications for pain management during palliative radiation treatments. A retrospective study was performed involving patients receiving palliative radiation to the brain, spine, or bone between January 1, 2016 and June 30, 2016. Patients receiving radiation at either a private academic hospital or an adjacent safety-net hospital were eligible for inclusion. Variables analyzed included treatment location, gender, socioeconomic status (SES), age, race, ethnicity, preferred language, comorbidity, and Karnofsky Performance Status (stratified into good, fair, and poor). Patients who received palliative radiation to the brain were analyzed separately from patients who received spine or bone radiation. Opioid access was defined as the presence of an active opioid medication prescription in the electronic medical record during palliative radiation therapy. Univariable (UVA) and multivariable (MVA) analyses were conducted to estimate odds ratios, corresponding 95% confidence intervals, and p-values using a logistic regression model. A total of 145 patients were included in the study. 34.5% (50) of patients received brain radiotherapy and 65.5% (95) of patients received spine or bone radiotherapy. 46.9% of patients were Hispanic, 32.4% of patients were non-Hispanic White, and 18.6% of patients were non-Hispanic Black. 54.0% of brain radiation patients had an opioid prescription during treatment, and 75.8% of spine or bone radiation patients had an opioid prescription during treatment. On MVA for brain radiation patients, less access to an opioid prescription was associated with higher SES vs. lower SES (OR 0.04, p = 0.05) and older age (65+ years old) vs. younger age (<65 years old) (OR 0.01, p = 0.03). On MVA for spine and bone patients, fair (OR 4.52, p = 0.03) and poor (OR 18.3, p = 0.02) vs. good functional status was associated with increased access to opioid medications. Treatment location, minority status, Spanish language preference, and SES had no impact on access to opioid medications during palliative radiation treatment. Instead, functional status played a major role in the receipt of medications for pain control. Continued vigilance is necessary to ensure underserved populations receive adequate pain control during palliative radiation.