3. Mitra McLarney, MD, MPH

Importance: Nearly half of all cancer patients experience pain, with treatment historically focused on opioid therapy. Little is known about how the treatment of cancer pain has been impacted by the opioid epidemic and the integration of nonpharmacologic approaches to pain management.

Objective: To describe annual trends in the use of opioids alone, nonpharmacologic treatments alone, multimodal multidisciplinary treatment, and neither treatment for adults with cancer-related pain. We assessed whether annual trends in the use of these pain treatments depended on education, poverty, race/ethnicity, and geography.

Design, Setting, and Participants: A serial cross-sectional design using Medical Expenditure Panel Survey (MEPS) data (2011-2020) was used to estimate the period prevalence of outpatient pain treatments among adult cancer survivors with pain.

Exposure: The primary exposure was calendar year (2011-2020). Annual trends were stratified by education, income, race and ethnicity, and geography.
Main Outcome: The use of mutually exclusive outpatient pain treatments (opioids-only, nonpharmacologic-only, both, or neither). Self-reported prescriptions were verified with respondents’ pharmacies.

Results: 3,103 respondents had both cancer and pain representing a prevalence of 39,182,365 adults. Most adults with cancer pain were >65 years of age (67.5%), female (52.3%), white (91.7%), non-Hispanic (95.9%), had a GED or high school diploma (42.4%), higher income (47.1%) and lived in the southern United States (38.1%). Between 2011 and 2020, the adjusted odds of receiving treatment with opioids (OR: 1.56 [95% CI, 0.90-2.68]), nonpharmacologic therapies (OR: 1.40 [95% CI, 0.88-2.23]), or both increased (OR: 2.34 [95% CI, 1.09- 5.00]); however, despite this rise, most (53.4%) did not receive either treatment. Annual trends in the use of opioids and/or nonpharmacologic treatment alternatives depended on income, educational attainment, race, and geographic region.

Conclusions and Relevance: Multimodal multidisciplinary pain treatments increased from 2011 to 2020; however, most cancer pain survivors remain untreated. Use of pain treatment varied by on sociodemographic and socioeconomic factors.