Analgesia profile and racial disparity in opioid use among cancer patients hospitalized in a public hospital in the countryside, Brazil.

Abstract

e13753 Background: Cancer-related pain is highly prevalent across all stages of oncologic disease and is considered one of the main causes of avoidable suffering. Opioids are internationally recommended for the management of moderate to severe cancer pain; however, their use is unevenly distributed worldwide, with markedly lower consumption in low- and middle-income regions. In the United States, studies consistently demonstrate racial disparities in opioid access and dosing, disproportionately affecting Black patients. In Brazil, although opioid use is largely restricted to acute and cancer-related pain, national data evaluating racial disparities in opioid prescription are scarce. This study aimed to characterize the analgesic profile of hospitalized cancer patients and to investigate whether racial disparities in opioid use are present in a Brazilian public hospital. Methods: A retrospective, observational, descriptive, and comparative study was conducted at a public cancer hospital in São Bernardo do Campo, Brazil. Medical records of adult patients with histologically confirmed cancer admitted between January and June 2024 were reviewed. Sociodemographic data (race/colour categorized as White or Black [Black and Brown]), clinical characteristics, and analgesia-related variables were collected, including opioid type, fixed and rescue dosing, and dose adequacy. Statistical analyses included Student’s t-test, chi-square test, and Z test for proportions (p < 0.05). Results: A total of 402 hospitalizations were included. Most patients received opioids, predominantly morphine. Although Black patients presented higher mean opioid doses and longer hospital stays, no statistically significant racial differences were observed in opioid prescription patterns, dosing, or rescue administration. These findings contrast with international literature. The absence of disparities may be related to the structure of the Brazilian public health system, specialized oncology care, and standardized prescribing practices. Limitations include possible misclassification of race/colour due to heteroidentification in medical records. Inadequate pain score documentation and frequent rescue dose calculation errors were identified. Conclusions: In this public Brazilian hospital, opioid use for cancer pain management appeared not to be racially disparity, with no statistically significant disparities between White and Black patients. Despite limitations inherent to retrospective designs and incomplete documentation, the study contributes novel national data on opioid distribution stratified by race. The findings underscore the need to improve pain assessment records, optimize opioid prescribing practices, and implement standardized analgesia protocols to enhance cancer pain control within the public health system.