title: Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).
abstract: Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer-related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population-based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management.
  
  
  
  The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors-II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health-related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment.
  
  
  
  Two-thirds of survivors reported at least 1 barrier to pain management. While patient-related barriers were most common, the greatest disparities were noted in provider- and system-level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed.
  
  
  
  Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management.
authors.affiliation: Behavioral Research Center, American Cancer Society, Atlanta, Georgia, USA. kevin.stein@cancer.org.|Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. kevin.stein@cancer.org.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Stein
authors.affiliation: Behavioral Research Center, American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Kassandra I
authors.initials: KI
authors.lastname: Alcaraz
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Chelsey
authors.initials: C
authors.lastname: Kamson
authors.affiliation: Behavioral Research Center, American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Fallon
authors.affiliation: Behavioral Research Center, American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Tenbroeck G
authors.initials: TG
authors.lastname: Smith
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000570:American Cancer Society; D000072716:Cancer Pain / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D059408:Pain Management; D011159:Population Surveillance; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology*
keywords: cancer; disparities; ethnicity; pain; pain management; race