E120: Disparities in Pain Management in Resectable Pancreatic Cancer

Introduction: The majority of patients diagnosed with pancreatic cancer experience disease-associated pain that impacts quality of life. Narcotic pain medications continue to be the mainstay of treatment, despite the proven effectiveness of celiac plexus blocks (CPBs). In this study, we aim to evaluate the modern utilization of opioid pain medications and CPBs in patients with pancreatic cancer.

Methods: A cross-sectional study was performed using the OneFlorida database, a de-identified clinical research network encompassing data from 15 million patients. Patients who underwent surgical resection for pancreatic ductal adenocarcinoma were identified using ICD9, ICD10, and CPT codes. RxNorm codes were used to assess opioid prescriptions and CPT codes were used to identify patients who underwent CPBs. Statistical significance was determined using the Chi-squared test for categorical values.

Results: 1059 patients who underwent surgical resection for pancreatic cancer were identified. Of these patients, 60.5% received an opioid prescription, whereas only 2.5% underwent CPB. Male (p=0.001), White (p< 0.0001), Non-Hispanic (p< 0.0001) and older patients (p< 0.0001) were more likely to be prescribed an opioid pain medication. Further, patients with private insurance were more likely to be prescribed opioids. Patients who underwent CPB were more likely to be Hispanic (p=0.029), younger (p=0.0001), insured by Medicaid (p< 0.0001) and were less likely to have been prescribed an opioid pain medication (p=0.010).

Conclusions: Symptoms of pain are undertreated in patients diagnosed with pancreatic cancer. CPB is grossly underutilized in the treatment of pain, despite its proven efficacy. Furthermore, disparities exist in the treatment modalities utilized to treat pain, particularly opioid pain medications.