Adherence to analgesics for cancer pain: A comparative study of african americans and whites using an electronic monitoring device

Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and whites using the Medication Event Monitoring System ( MEMS ). Patients ( N = 207 ) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia ( ≥18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least 1 prescription of oral around-the-clock analgesic ). African Americans reported significantly greater cancer pain ( P < .001 ), were less likely than whites to have a prescription of long-acting opioids ( P < .001 ), and were more likely to have a negative Pain Management Index ( P < .001 ). There were considerable differences between African Americans and whites in the overall MEMS dose adherence, ie, percentage of the total number of prescribed doses that were taken ( 53% vs 74%, P < .001 ). On subanalysis, analgesic adherence rates for African Americans ranged from 34% ( for weak opioids ) to 63% ( for long-acting opioids ). Unique predictors of analgesic adherence varied by race; income levels, analgesic side effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for whites.