Racial Disparities in Analgesic and Psychiatric Medication Use During End-Of-Life Care in Advanced-Stage Colorectal Cancer: A Retrospective Cohort Study

Abstract

This study examined racial and ethnic disparities in the use of analgesic and psychiatric medications during end-of-life care among Medicare beneficiaries with advanced-stage colorectal cancer. Using the Surveillance, Epidemiology, and End Results-Medicare-linked database from 2005 to 2017, we identified 28,212 patients with stage IV colorectal cancer who died within 1 year of diagnosis. Multivariable logistic regression models were used to assess differences in medication use by race and ethnicity. Compared with non-Hispanic White patients, Black patients had significantly lower odds of opioid use [adjusted OR (aOR) = 0.86; 95% confidence interval (CI), 0.80-0.93] and overall analgesic use, whereas Hispanic patients had higher use of opioids (aOR = 1.12; 95% CI, 1.03-1.22) and non-opioid analgesics (aOR = 1.22; 95% CI, 1.06-1.40). Asian patients had increased non-opioid use (aOR = 1.71; 95% CI, 1.44-2.03) and decreased skeletal muscle relaxant use (aOR = 0.59; 95% CI, 0.43-0.82). Across all minority groups, psychiatric medication use was consistently lower than in non-Hispanic White patients. These disparities persisted after adjusting for demographic, clinical, and socioeconomic factors. Findings highlight the urgent need for equitable, culturally responsive symptom management strategies to improve the quality of end-of-life care in this population.

Significance: We identified significant disparities in the use of analgesic and psychiatric medications among patients with advanced-stage colorectal cancer. Our findings are significant given the emerging importance of symptom management on health-related quality of life and survival. Future research is needed to understand causal factors, their influence on patient-reported outcomes such as symptom relief, and the development of strategies to close these medication use gaps.