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| EXCEED Pilot Project 4 |
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| Pain Management of Ambulatory African-American
and Caucasian Patients with a Diagnosis of Cancer |
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Statement of the Problem:
Untreated pain in terminally ill patients in the United States is a major problem.
Although more than 90% of pain can be effectively treated, the SUPPORT study revealed
that more than 50% of hospitalized dying patients experienced moderate to severe
pain during the last three days of life. Numerous barriers exist to account
for poor pain control. There is a need for baseline data comparing pain management
of out-patient African-American and Caucasian patients with a diagnosis of cancer.
Numerous studies have indicated the existence of disparities between health care
provided to African-American and Caucasian patients. Evidence also suggests that
disparities exist in pain management for African-American patients and Caucasian
patients. There is under-utilization of hospice services by African-American patients.
Older patients also have reduced expectations for pain control. There is a need to
obtain data regarding effectiveness of pain symptom management forolder ambulatory
African-American patients compared with Caucasian patients having a diagnosis of cancer.
Hypothesis:
There is variation in the management of cancer pain as a function of race. Older
African-American patients experience suboptimal control of pain associated with
advanced cancer when compared witholder Caucasian patients matched for age, sex,
cancer type and stage.
Specific Aims:
- Evaluate pain management of ambulatory out-patients with advanced cancer diagnoses.
- Determine time of initiation of out patient opioid and other analgesic medications,
frequency of use and total dosage of specific medications (i.e., morphine and others)
utilized over course of the terminal illness.
- Determine if inter-generational differencesand racial differences exist in
pain management strategies, including frequency of usage of potent opioid (narcotic)
analgesic medications, and other prescription drugs used for effective pain control
as a function of patient age.
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