The role of ethnicity in opioid prescribing and health service use in the last three months of life: a population-based comparative cohort study of cancer patients

Pain affects up to 90% of cancer patients near the end of life and can be very distressing. Relieving cancer pain is a top priority for patients, families and healthcare providers. While effective opioid pain medications exist, research shows they are often underprescribed, particularly in some communities. 

Ethnic disparities in cancer pain management

In the UK, annual surveys show that cancer patients from Black, Asian and ethnicity diverse communities are less satisfied with how their pain is managed compared to other groups. However, no research has specifically examined pain medication prescribing patterns across different ethnic groups for patients at the end of life.

Aims of this study

For the first time in the UK, this study by ARC palliative and end of life care researchers will describe the relationship between ethnicity and community prescribing patterns of opioids among cancer patients towards the end of life in the UK. It aims to:

• Analyse opioid painkiller prescribing patterns by ethnicity for cancer patients nearing the end of life 
• Examine use of primary and secondary health services by ethnicity for these patients
• Evaluate the independent relationship between opioid prescribing and ethnicity

The study will include cancer patients across England, including patients from south London, with a focus on those from diverse communities diagnosed with lung, bowel, breast and prostate cancers who died between 2011 and the latest available data.

Our methods 

Researchers will use nationwide linked primary care, hospital and mortality data to study a population-based cohort of deceased cancer patients. Opioid prescriptions will be classified as weak or strong, and analyses will examine:

• Whether patients received any weak or strong opioid prescriptions
• Number of prescriptions 
• Average daily doses
• Total doses 
• Days supplied

Importantly, this study has been designed in close collaboration with patient and public members from diverse ethnic communities. This includes co-designing an online consultation with people from BAED communities across the UK with advanced cancer and bereaved relatives. Their perspectives on cancer pain and its management helped shape the research.

Our collaborators

We are working closely with patients, families, GPs, local and national community groups, and researchers from King’s College London and Hull York Medical School.