M-POST:

Blue Cross Blue Shield of Michigan

Project Title: 

Living with Cancer: The Quality of Cancer Pain Management in African Americans

Context: 

Cancer related pain is the most common complaint of cancer patients.  Racial and ethnic minorities are at risk for the under-treatment of cancer pain.  When considering the persistence of healthcare disparities based upon race and ethnicity, especially for cancer, the presence of cancer pain in this population has significant implications on health-related quality of life (HRQOL).  The overriding hypothesis for this proposal is that breakthrough pain in cancer patients has a greater negative effect on the HRQOL (i.e., physical, social, and emotional health) of African Americans when compared to Caucasian Americans.

Objectives: 

This study will identify and compare the prevalence, characteristics, and outcomes of breakthrough pain (a transitory increase in pain intensity despite a fixed analgesic regimen) in African and Caucasian Americans with cancer pain.  Specifically, it will evaluate and compare socio-demographic and coping factors that influence the experience of breakthrough pain in a cancer pain population. Lastly, this study will investigate and compare the relationship between breakthrough pain and HRQOL, healthcare utilization, and medical expenditures in African and Caucasian Americans with cancer pain.

Research Design and Methods: 

The proposed research will prospectively compare the prevalence and consequences of breakthrough pain (e.g., hospitalizations, emergency department visits, and physician visits) via semi-structured interviews (SI) and well-validated survey instruments. To chronicle the consequences of breakthrough pain, a series of repeated self-administered questionnaires used to assess HRQOL, pain severity, depression, attitudes regarding pain, and coping will be mailed to participants in a standardized format over a six-month period to assess HRQOL.  Data on healthcare utilization, medical expenditures, and breakthrough pain will also be collected via study-specific diaries. To enhance the quantitative data, SI will be used to obtain information regarding physician-patient communication and experience with pain care services. 

Participants: 

To facilitate this observational study, subjects with cancer pain due to advanced breast, prostate, colorectal, or lung cancer will be recruited from community-based cancer centers.  A cohort of African Americans with cancer pain (study group; n = 100) will be compared to a cohort of Caucasian Americans with cancer pain (comparison group; n = 100). 

Expected Outcomes/Results: 

This health services research study will be the first of its kind to offer prospective data on the impact of breakthrough pain on HRQOL, healthcare utilization, and medical expenditures in African Americans with cancer pain.  If our hypotheses are correct, we expect to establish the presence of race and ethnic-based “pain care gap”.  Ultimately, new knowledge about the HRQOL outcome variables that are most affected in African Americans with breakthrough pain due to cancer will encourage the development of specific strategies designed to enhance cancer pain management which will improve the health of African Americans and other vulnerable populations with cancer pain.

AETNA

Project Title:

The Health Outcomes and Quality of Care of African Americans Living With Chronic Pain

Context:

Chronic pain (CP) has significant health effects.  African Americans (AA) may differentially experience more impairment due to CP than Caucasian Americans (CA). 

Objectives:  

This study is closely aligned with the Quality Care Research Fund and Aetna’s goal to improve the health of Americans and to eliminate healthcare disparities.   It will prospectively explore the effects of CP on overall health and QOL (i.e., emotional, physical, and social health) as well as evaluate the quality of care (QOC) that AA with CP receive

Research Design and Method: 

This prospective longitudinal cohort study will compare AA with CP (study group) to CA with CP who are matched by gender (control group) for six months. We will test the general hypothesis that the presence of CP has a greater negative impact on overall health and QOL of AA than upon CA.  The specific aims of this study are to: 1) evaluate the overall health status and QOL of AA with CP, 2) identify potential socio-demographic and behavioral factors that influence coping with CP, and 3) evaluate the QOC received by AA with CP.   Part I of the study will chronicle the CP experience of AA by using a battery of well-validated survey instruments.  Part II consists of two-structured telephone interviews (SI) designed to evaluate QOC prior to being seen at the Multidisciplinary Pain Center (MPC) and at the conclusion of the study

Patients and Other Participants: 

AA and CA subjects with CP age 18-55 years, who are seeking treatment at the MPC will be studied

Main Outcome Measure(s): 

The differential effects of CP on health status and QOL

Expected Outcomes/Results:  

This health services research study will be the first to offer quantitative and qualitative data regarding the QOL and QOC of AA living with CP.  The potential benefits of studying CP in AA have tremendous public health implications.  We expect to establish the presence of a “pain care” gap based on race.  New knowledge about the differential effects of CP in AA will encourage the development of specific healthcare strategies designed to address these factors.  It will extend the existing pain literature and scientific knowledge by examining the influence of race/ethnicity on CP while providing a preliminary understanding of how AA are differentially impacted by the presence of CP.

Geriatric Center, Hartford and Claude Pepper Center

Title of Project:

Health Outcomes and Quality of Care of Older Women Living With Chronic Pain

Abstract:

‘Stark differences in the healthcare experience based upon race, ethnicity, gender, and social stratification exist. Women may suffer substantially more disability due to chronic pain than men may. However, little is known about the effects of chronic pain on the health status, quality of life (QOL i.e., physical, social, and emotional health), or quality of care received by older women. The proposed research will provide a preliminary understanding of the potential differential impact of chronic pain on the health status and QOL of women as well as provide valuable insight into the quality of care received.  This study will recruit a cohort of women age 50 and older, who have chronic pain (population of interest) and present at the UM Multidisciplinary Pain Center.  A cohort of women matched by age without chronic pain (control group) obtained from the human subjects core of the Claude Pepper (i.e., women who have previously volunteered to participate in research).  The subjects will be compared using quantitative and qualitative methodology. Subjects will receive three surveys (baseline, three months and six months) and two interviews (baseline and six months) by phone.  Surveys will collect information regarding physician-patient communication, satisfaction with pain care, coping styles, coexisting morbidities, support systems, pain characteristics, patient demographics, environment (e.g., employment), and social behavior (e.g., alcohol abuse, tobacco use). Interviews will be used to collect information on the quality of care that patients receive.   The ultimate research goal is to test the general hypothesis that chronic pain has a negative impact on the overall health and QOL of older women when compared to a control group.

Michigan Center for Urban African American Aging Research

Project Title:

Chronic Pain in African American Elders: A Quality of Life and Mental Health Outcomes Study

Abstract: 

Race and age are crucial elements in the consideration of pain management. Despite the importance of these factors there is a dearth of knowledge regarding the nature of presenting symptoms, duration of pain complaints, and level of disability due to chronic pain in African American (AA) elders. We do not know if the increased depression and anxiety seen in chronic pain patients may be even more pronounced in AA elders with chronic pain. Comparisons between Caucasian and AA elders in their perceptions of pain management and pain belief systems will be considered. Our study offers the innovative multidisciplinary research that is required to realize the influences of age and ethnicity on the individual's pain experience.

Specific Aims:

• Specific Aim 1.  Hypothesis: There is no difference in pain characteristics, assessment of pain, health and pain beliefs of AA elders with chronic pain when compared to CA elders. 

• Specific Aim 2. Hypothesis: There is no difference in the Quality of Life (QOL) or disability of AA elders with chronic pain when compared to CA elders.

• Specific Aim 3.  Hypothesis: There is no difference in the mental health or coping of AA elders with chronic pain when compared to CA elders. 

Lance Armstrong Foundation 

Project Title:

Chronic pain in cancer survivors: Examining disparities and quality of life.

Context:

Pain has been shown to be related to poorer quality of life. Furthermore, pain is present for 80% of people with cancer and 40% of survivors five years later. Yet careful studies of pain etiology, characteristics, treatment and impact on quality of life have not been done. Likewise, although racial disparities are widely established in other areas of health and healthcare, disparities have not been examined in relation to chronic pain (i.e., persisting > 6 months) in cancer survivors. We plan to address this gap in the literature in the current study.

Objectives:

This study hypothesizes that black cancer survivors have a higher prevalence of cancer-related chronic pain than whites and that the etiology and characteristics of chronic pain differ among the two groups. We hypothesize that the presence of cancer-related chronic pain in cancer survivors results in worse mental health, diminished functioning and lower Health-related Quality of Life (HRQL); and that this effect is stronger for black survivors when compared to white survivors. We further hypothesize that differences in coping, pain care, attitudes about pain, and socio-demographic factors between black and white cancer survivors influence the prevalence of cancer-related chronic pain and mediate the impact of cancer-related chronic pain on HRQL.

Research Design and Methods:

This study will use a three year, cross-sectional survey design. We will recruit black and white subjects who are randomly chosen from the Michigan Cancer Registry, living in the Detroit Metropolitan area which has broad racial diversity.

Participants:

Subjects will be those who were diagnosed with breast, prostate, colorectal, and lung cancer or multiple myeloma (N = 220), whether they currently have cancer or are disease free survivors. Black subjects will be oversampled if necessary, to ensure equal numbers of blacks and whites for racial comparisons. We will study the pain experiences of black (study group; n = 110) and white (comparison group; n = 110) subjects who have been diagnosed with cancer and have chronic pain for more than two years but less than ten years.

Expected Outcomes/Results:

Specifically, the proposed research will describe and compare the pain experience and the consequences of pain in cancer survivors via validated survey instruments. Socio-demographic information (e.g., age, gender, residence) cancer etiology and treatment, experiences with pain and pain care, coping, attitudes about pain care, depression, disability and health related quality of life (HRQL) will be collected.

Relevance:

With this study we hope establish the prevalence, etiology, characteristics and impact of pain in people who are cancer survivors and examine racial differences in pain experiences. This study will provide a sound basis for educating physicians and cancer survivors about the role of pain and how appropriate pain management may improve quality of life.

Dept. of Anesthesiology, Univ. of Michigan Medical School

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