Authors: Lamba N, Mehanna E, Kearney RB, Catalano PJ, Haas-Kogan DA, Alexander BM, Cagney DN, Lee KA, Aizer AA
Title: Racial disparities in supportive medication use among older patients with brain metastases: A population-based analysis.
Journal: Neuro Oncol :-
Date: 2020 Mar 09
PubMed ID: 32149345
Abstract: BACKGROUND: Brain metastases (BM) cause symptoms that supportive medications can alleviate. We assessed whether racial disparities in supportive medication utilization after BM diagnosis exist. METHODS: SEER-linked, Medicare-enrolled patients diagnosed with BM between 2007-2016 were identified. Fourteen supportive medication classes were studied: non-opioid analgesics, opioids, antiemetics, antiepileptics, headache-targeting medications, steroids, cognitive aids, antidepressants, anxiolytics, anti-delirium/antipsychotic agents, muscle relaxants, psychostimulants, sleep aids, and appetite stimulants. Drug administration ≤30 days following BM diagnosis was compared by race using multivariable logistic regression. RESULTS: Among 17,957 patients, headache aids, antidepressants, and anxiolytics were prescribed less frequently to African Americans (OR=0.81 [0.73-0.90], p<0.001, OR=0.68 [95% CI 0.57-0.80], p<0.001, and OR=0.68 [0.56-0.82], p<0.001, respectively), Hispanics (OR=0.83 [0.73-0.94], p=0.004, OR=0.78 [0.64-0.97], p=0.02, and OR=0.63 [0.49-0.81], p<0.001, respectively), and Asians (OR=0.81 [0.72-0.92], p=0.001, OR=0.67 [0.53-0.85], p=0.001, and OR=0.62 [0.48-0.80], p<0.001, respectively) compared to non-Hispanic Whites. African Americans also received fewer antiemetics (OR=0.75 [0.68-0.83], p<0.001), steroids (OR=0.84 [0.76-0.93], p<0.001), psychostimulants (OR=0.14 [0.03-0.59], p=0.007), sleep aids (OR=0.71 [0.61-0.83], p<0.001), and appetite stimulants (OR=0.85 [0.77-0.94], p=0.002) than Whites. Hispanic patients less frequently received anti-delirium/antipsychotic drugs (OR=0.57 [0.38-0.86], p=0.008), sleep aids (OR=0.78 [0.64-0.94, p=0.01), and appetite stimulants (OR=0.87 [0.76-0.99], p=0.04). Asian patients received fewer opioids (OR=0.86 [0.75-0.99], p=0.04), antiemetics (OR=0.83 [0.73-0.94], p=0.004), antiepileptics (OR=0.83 [0.71-0.97], p=0.02), steroids (OR=0.81 [0.72-0.92], p=0.001), muscle relaxants (OR=0.60 [0.41-0.89], p=0.01), and appetite stimulants (OR=0.87 [0.76-0.99], p=0.03). No medication class was prescribed significantly less frequently to Whites. CONCLUSIONS: Disparities in supportive medication prescription for non-White/Hispanic groups with BM exist; improved provider communication and engagement with at-risk patients is needed.