Racial Gaps in Cancer Pain Management Persist in Community Care: Ila Sruti, 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 new study presented at the 2026 American Society of Clinical Oncology Annual Meeting drew on electronic medical record data from The US Oncology Network to characterize racial differences in pain medication prescribing among more than 100,000 patients with breast, prostate, and pancreatic cancer treated in community oncology settings between January 2021 and June 2025.

The findings revealed that among patients with breast cancer, the 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, where Asian patients waited a median of 86 days for pain medication compared with 50 days for White patients, and received strong opioids at notably lower rates (28% vs 54% in Black patients and 50% in White patients). Gaps narrowed considerably in pancreatic cancer, where pain medication use and strong opioid prescribing were 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: This study used data from a large national community oncology network. How important is it to evaluate these disparities in community settings specifically, rather than only in academic medical centers?

Sruti: Assessing treatment patterns in the community setting is critical because this is where the majority of cancer care in the United States is delivered, and so the results reflect routine real-world oncology practice across a highly diverse patient population. Studying trends at this large national community network level, we're capturing a more generalizable view of oncology care and then identifying disparities in the setting where most patients receive their treatment. And as a result, it's also where there's the greatest potential to drive meaningful, actionable systemwide improvements in patient care and outcomes.

AJMC: The findings suggest that inequities in pain management may vary by malignancy and medication category. How should clinicians and health systems tailor interventions to better address these cancer-specific differences?

Sruti: This study, as we've established, assessed pain management across the 3 different cancers: breast, prostate, and pancreatic, and then also assessed pain management overall, as well as the receipt of strong opioids. So, the treatment patterns that we saw, they differ by cancer type and by medication category, which suggests that interventions need to be more targeted and clinically contextualized. For example, cancers with different symptom burdens or treatment trajectories or expectations around pain, they may require different approaches to either screening, symptom assessment, or supportive care integration. In short, pain management is not a one-size-fits-all approach, and our studies suggest that cancer-specific, treatment-specific, and culturally informed interventions are necessary for equitable symptom management, specifically among breast and prostate cancer.

The study demonstrated that there needs to be a focus on both receipt of appropriate pain management, as well as that timing to pain management, whereas for pancreatic cancer, receipt of appropriate pain management would be the focus from a US oncology provider perspective, of which I am not, obviously, but from that perspective, this underscores the value of standardized pain assessment as we alluded to earlier, timely escalation pathways, and also just this ongoing evaluation of prescribing patterns to ensure that culturally aware care that supports more equitable outcomes is occurring.

AJMC: Looking ahead, what additional research is needed to better understand whether these prescribing differences are influenced by patient preferences, provider bias, access to supportive care, or broader systemic barriers?

Sruti: There are several avenues for future research to further build on these findings. First, I think this research question should be evaluated across additional cancer types and broader patient populations, including other racial groups that are often underrepresented in the research. Second, the study was a descriptive study, utilizing structured data from the electronic health records from community oncology practices, and so I think future work may benefit from incorporating additional data sources, such as claims data, sociodemographic variables, and patient-reported outcomes, to extend the findings of the study and provide a more complete understanding of the pain management pathway. And then, lastly, I think multivariable analyses to assess factors impacting both overall pain medication use and a strong opioid, specifically, would be particularly informative. Overall, the findings from this study suggest that there are important cancer-specific racial inequities in pain management that likely require multilevel interventions.

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(16 suppl):1650. doi:10.1200/JCO.2026.44.16_suppl.1650