1650 Background: Patients (pts) from racially and ethnically minoritized populations are less likely to receive opioid analgesics for cancer-related pain, raising concern for inequitable symptom management. Although guidelines support opioid therapy within a multimodal approach, large scale evidence on racial differences in pain medication use across cancer types remains limited. This study uses real-world data from a large community oncology network to evaluate prescribing patterns of pain medication among high prevalence and high pain burden cancers by race and cancer type. Methods: Electronic medical record data from The US Oncology Network identified pts diagnosed with breast, prostate, or pancreatic cancer between January 2021 and June 2025, followed through December 2025. Pain medication (acetaminophen, NSAID, opioid) prescriptions and median time from cancer diagnosis to pain medication prescription were described. Strong opioids were defined as fentanyl, hydromorphone, morphine, or oxycodone, while general opioid use included hydrocodone and tramadol. Results: Among breast cancer patients overall (58,308 White; 7,705 Black; 3,652 Asian), pain treatment was received by 19% of White pts and by 24% of both Black and Asian pts, with median time to first pain medication shortest for White patients (65 d) and longest for Black patients (80 d). Prescriptions for strong opioids for breast cancer were lowest among Asian patients (28%), compared to 32% in Black patients and 35% in White patients. Among prostate cancer overall (19,268 White; 3,385 Black; 469 Asian), where receipt of pain medication was 17%, 20%, and 15%, respectively, Asian pts experienced the longest time to pain medication (86 d) versus the shortest among White patients (50 d). Asian patients had the fewest prescriptions for strong opioids (28%) compared with Black (54%) and White patients (50%). In pancreatic cancer (7,972 White; 1,035 Black; 330 Asian), pain medication prescriptions overall (52%, 55%, 50%, respectively) and for strong opioids (71%, 68%, 73%, respectively) were comparable across racial groups, and median time to pain medication showed minimal variation (18–22 d). Conclusions: In this large, nationally representative community oncology population, clinically meaningful racial differences in time to pain medication initiation and strong opioid prescribing were observed for breast and prostate cancer but not pancreatic cancer. Minoritized populations experienced delays in pain management, and Asian patients consistently received fewer strong opioid prescriptions. These results highlight that inequities in pain management vary across malignancies, and categories of pain medication. These findings underscore the need for culturally informed, cancer specific interventions to promote equitable symptom management.
Sruti et al. (Wed,) studied this question.