Data Reveal Racial Disparities in Oncology Pain Prescribing: Ila Struti, MPH

Patients from racially and ethnically minoritized populations have long faced inequities in cancer pain management, yet large-scale real-world evidence documenting these gaps across cancer types has remained limited. A study presented at the 2026 American Society of Clinical Oncology Annual Meeting found that among patients with breast cancer treated in community oncology settings, median time to first pain medication was shortest for White patients (65 days) and longest for Black patients (80 days), while Asian patients received strong opioid prescriptions at lower rates than both Black and White patients (28% vs 32% and 35%, respectively). Disparities were similarly pronounced in prostate cancer but narrowed considerably in pancreatic cancer, where pain medication use was largely comparable across racial groups. The American Journal of Managed Care^® (AJMC^®) spoke with lead author Ila Sruti, MPH, outcomes researcher at Ontada, about what these patterns reveal and what interventions may be needed to promote more equitable symptom management.

This interview has been lightly edited for clarity.

AJMC: Your study found that Black and Asian patients with breast and prostate cancer experienced longer delays to pain medication initiation compared with White patients. What factors do you believe may be driving these disparities in real-world oncology care?

Sruti: First, the pain medications that we assessed were acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids. What we observed was that among breast cancer patients, Asian patients experienced a median delay of 9 days to that pain medication initiation, and Black patients had a median delay of 14 days compared with White patients. Similarly in prostate cancer, the delays were 29 days for Asian patients and 4 days for Black patients, and so the aim of this study was to characterize and quantify the extent of these differences within the contemporary community setting.

The study was not designed to determine the drivers of the prescribing differences or the factors of the prescribing differences we observed, but the fact that we saw such a consistent pattern definitely suggests that it's an area that should be further investigated. That being said, factors associated with pain management disparities overall have been shown in prior literature, and so it follows that many of those factors are likely, at least in part, at play here. I think some of those are patient-level factors, such as differences in reporting of symptoms or perceptions of pain across racial groups.

At the provider level, there may be differences in how pain is recognized or addressed, and then, additionally, I think there may be workflow or access-related challenges within the community oncology setting that would also be a factor. One last thing: it’s important to note that this study, which used structured electronic health records, is just one piece of the puzzle, or one piece of the broader picture, to give us a sense of what’s happening in the community oncology setting.

AJMC: One of the more striking findings was that Asian patients consistently received fewer prescriptions for strong opioids across multiple cancer types. Were you surprised by this result, and do you have any thoughts about why this pattern emerged?

Sruti: One thing that's important to know was that these data demonstrated that Asian patients received similar proportions of pain prescriptions overall, across the cancer types of test, yet still received a lower proportion of strong opioids, like you said. So 15% of Asian patients diagnosed with breast cancer received a prescription for a strong opioid compared with 23% of White patients diagnosed with breast cancer. That's a difference of 8%, and again, similarly, 24% of Asian patients with prostate cancer received a prescription for a strong opioid compared with 39% of White patients with prostate cancer, so a difference of 15%, which is indeed striking. 

Another item to note is that this population—Asian patients—has been historically underrepresented in research, especially pertaining to pain management. Frequently, Asian patients will be aggregated or categorized as part of a larger other group, which then restricts any subgroup-specific analyses from being conducted. I think one strength of this study, specifically, is the ability to examine this relatively large cohort of Asian patients across multiple tumor types. In our study, we saw 3652 Asian patients with breast cancer, 469 Asian patients with prostate cancer, and 330 Asian patients with pancreatic cancer.

Similar to my response to the last question, the patient-level and provider-level factors, the factors as a whole that were impacting receipt of prescriptions of strong opioids were not specifically assessed in the study. But again, echoing the factors discussed earlier, this idea of cultural perception around pain and opioid use, and also, at the provider level, variation in how that pain is assessed and managed are certainly factors, broadly speaking. Again, prior research suggests that differences can emerge quite early in the care pathway, including during initial pain evaluation.

AJMC: The racial differences in pain management appeared much less pronounced in pancreatic cancer compared with breast and prostate cancer. What might explain why disparities narrowed in a cancer type associated with a higher pain burden?

Sruti: The aim of this study was to assess pain management across high-prevalence cancers, breast and prostate, and then also cancers with a high pain burden—pancreatic. Pancreatic cancer, as you said, it's associated with higher and more consistent pain burden, and so there's likely a clearer, more well-established, or standardized pathway for supportive pain management. As a result, that very variability in treatment may narrow, and treatment, as you said, becomes more uniform across the groups. Overall, we saw that strong opioids were prescribed in over half of patients with pancreatic cancer across all groups.

However, 58% of Black patients with pancreatic cancer received strong opioids compared with 64% of White patients with pancreatic cancer. So, although the differences narrowed, they were certainly still present. From our perspective, this reinforces the idea that standardized care pathways can help reduce variability, but there still may be additional opportunities to ensure more consistent, equitable pain management across all groups of patients.

Reference

Sruti I, Su Z, Reid RL, Paulus J. Racial variation in pain medication prescriptions among breast, prostate, and pancreatic cancer patients treated in a large community oncology setting [abstract]. J Clin Oncol. 2026;44(suppl 16):1650. doi:10.1200/JCO.2026.44.16_suppl.1650