Racial Disparities in Non-Stigmatized Supportive Care Medication Use in Pancreatic Cancer.

Abstract

Pancreatic cancer (PC) is associated with a high symptom burden that contributes to reduced health-related quality of life (HRQoL) and adverse clinical outcomes. Supportive care medications (SCMs) are essential for symptom management. Prior studies have documented racial disparities in the use of stigmatized medication classes such as opioids and psychotropics. However, less is known about whether similar disparities exist for non-stigmatized SCMs. This study examined racial and ethnic differences in the use of non-stigmatized SCMs during end-of-life care among patients with PC. We conducted a retrospective cohort study using SEER-Medicare data from 2005 to 2017. Patients with PC who had continuous Medicare Parts A, B, and D coverage and died within 12 months of diagnosis were included. SCM use was defined as at least one outpatient prescription claim for antiemetics, appetite stimulants, cognitive aids, headache aids, or sleep aids. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for SCM use by race and ethnicity, controlling for demographic, clinical, and socioeconomic factors. The final cohort included 74,309 patients (Non-Hispanic White: 72.5%, Black: 11.0%, Hispanic: 9.6%, Asian/Pacific Islander: 6.6%). Compared to Non-Hispanic White patients, Black patients had lower use of antiemetics (aOR 0.77; 95% CI: 0.73-0.81), headache aids (aOR 0.68; 95% CI: 0.63-0.74), and sleep aids (aOR 0.68; 95% CI: 0.64-0.72), but higher use of appetite stimulants (aOR 1.06; 95% CI: 1.01-1.11) and cognitive aids (aOR 1.38; 95% CI: 1.25-1.53). Similar patterns were observed for other racial and ethnic minority groups, though findings varied by medication class. Racial and ethnic disparities persist in the use of non-stigmatized SCMs among patients with PC at the end of life. These findings extend prior evidence on inequities in cancer symptom management and underscore the need for interventions that promote equitable access to SCMs across diverse populations.