Many people diagnosed with advanced-stage cancer have some level of pain -- from mild to severe and from short episodes to longer-lasting pain. Studies have found that 56% to 75% of people with advanced-stage disease report pain as a side effect.
Pain can affect your quality of life, your mood, your ability to function and move, your appetite, and your sleep. So it’s important that pain be treated. Don’t believe the common assumption that because cancer is a serious disease, some level of pain is to be expected and accepted.
Palliative, or supportive, care is a team-based approach in which a group of professionals -- including doctors, nurses, social workers, psychiatrists, dietitians, and chaplains -- focuses on relieving the pain, anxiety, and stress that cancer can cause. Palliative care doesn’t fight cancer, but it does ease pain and improve quality of life in many situations.
Palliative care isn’t the same as hospice care. Hospice care is reserved for people facing the end of life, usually within 6 months. Palliative care is for anyone who needs help dealing with the physical pain, stress, and anxiety a serious illness can cause. Still, many people in hospice receive palliative care.
Studies have found that treatment for breast cancer can vary by race. Black women are less likely than white women to:
- have genetic testing for gene mutations linked to breast cancer
- have Oncotype DX genomic testing to help determine the risk of cancer recurrence
- be treated with Herceptin (chemical name: trastuzumab)
So researchers wanted to know if there were differences in the supportive, palliative medicines given to Black and white women diagnosed with stage IV breast cancer.
A study suggests that Black women are less likely to receive antidepressants and sleep aids than white women. While this didn’t seem to lessen the quality of their end-of-life care, it may mean that Black women’s symptoms aren’t being well-managed.
The research was published online on May 9, 2016 by the Journal of Clinical Oncology. Read the abstract of “Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer.”
To do the study, the researchers looked at the medical records of 883 women age 65 and older whose first diagnosis was stage IV breast cancer:
- 752 (85.2%) were white
- 131 (14.8%) were Black
The women were diagnosed between 2006 and 2012 and had Medicare as their insurance plan.
The researchers looked to see what type of supportive medicines the women used in the 90 days after they were diagnosed, including antidepressants, pain medicines, and sleep aids. The researchers also looked at the end-of-life care the women received, including:
- whether they used hospice care
- whether they were treated with chemotherapy in the 14 days before they died
- whether they were hospitalized when they died
- whether they were admitted to a hospital intensive care unit, had an emergency room visit, or more than one hospitalization in the 30 days before they died
Both Black and white women had similar treatments for the breast cancer, and both groups of women were equally likely to have been treated with opioid pain medicines, such as codeine, Vicodin (chemical name: hydrocodone/acetaminophen), and OxyContin (chemical name: oxycodone).
But there were differences in the use of other types of pain medicines. Compared to white women, Black women were about 44% less likely to be prescribed non-opioid psychotropic medicines, including antidepressants such as Tofranil (chemical name: imipramine) and Cymbalta (chemical name: duloxetine) and anti-seizure medicines such as Neurontin (chemical name: gabapentin). These medicines also can be used as sleep aids.
Other differences in care by race were:
- Black women were 14% less likely to use hospice care than white women.
- Black women were 60% more likely to die in the hospital than white women.
- Black women were 30% more likely to have been admitted to an intensive care unit or have more than one hospitalization or emergency room visit in their last 30 days of life than white women.
The researchers said these differences, while troubling, didn’t seem to lessen the quality of the women’s end-of-life care.
“Although we did not find evidence of a relationship between supportive medications use and end-of-life care, disparities in supportive medication use are concerning as they could point to inadequate symptom management and reduced quality of life,” said Devon Check, Ph.D., research fellow at the University of North Carolina Gillings School of Global Public Health in an interview. “Studies have found that early introduction of palliative or supportive care is tied to higher rates of hospice use and less intensive end-of-life care, both of which are markers of high-quality end-of-life care.
“To our knowledge, ours is the first study to demonstrate disparities in the use of supportive care medications,” she continued. “It is important for patients and providers to communicate about supportive care needs and preferences -- like the management of symptoms of anxiety, depression, insomnia, and pain -- to alleviate patient distress and suffering. In order to determine whether disparities in medication utilization indicate disparities in quality, future research should include data on patients’ supportive care need and preferences surrounding medication use.”
The study did have some limitations:
- only women who had Medicare insurance were included
- other types of supportive care, such as counseling and decision-making support, weren’t included in medical records
- the women’s individual preferences couldn’t be accounted for
If you’ve been diagnosed with advanced-stage breast cancer, it makes sense to think about both the kinds of treatment you want and don’t want as you develop your treatment plan. You are your own best advocate, so don’t be afraid to speak up to get the treatment that you prefer.
You and your doctors need to be in agreement about the approach to your care. So it’s also a good idea to regularly review your feelings and treatment goals with your medical team. You may want to alter your treatment plan depending on how you feel, your quality of life, family issues, and/or financial concerns. It’s important to know that your treatment plan isn’t written in stone. You can talk to your doctor about changing it at any time.
For more information on supportive care for advanced-stage disease, visit the Breastcancer.org Palliative Care for Recurrent or Metastatic Breast Cancer pages.
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