3455 - Pain Response to Palliative Radiation Therapy in Korean American Cancer Patients with Metastases to Bone
Presenter(s)
I. Kang1, K. Pang2, J. J. Park3, S. Baek4, G. K. In5, N. Lee5, A. Y. Han6, A. Kim7, and S. K. Yoo3; 1Keck School of Medicine, University of Southern California, Los Angeles, CA, 2University of Notre Dame, Notre Dame, IN, 3Department of Radiation Oncology, Los Angeles General Medical Center, Los Angeles, CA, 4University of California, Los Angeles, Los Angeles, CA, 5Department of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 6Keck Medicine of USC, Department of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, 7GI Center of California, Los Angeles, CA
Purpose/Objective(s): Ethnic differences in pain catastrophizing, sociocultural factors, and variations in analgesic use may affect pain perception among cancer patients. Prior studies suggest such differences in pain response to radiation therapy (RT), but data on subgroups such as Korean Americans is limited. This study aims to investigate differences in pain response to palliative RT to bone metastases between Koreans and non-Koreans.
Materials/Methods: An IRB-approved retrospective review of an urban academic center was conducted for patients with bone metastases who received palliative intent RT between 2019 and 2023. Patients without initial pain (score=0) were excluded. Patient demographics including physician ethnic concordance, pre-RT and post-RT pain scales, radiation treatment details, analgesic usage, and re-irradiation rates were recorded. Robust pain response was defined as a =4 decrease in pain score. Statistical analyses included chi-square test and multivariate logistic regression (MLR).
Results: A total of 131 patients, 62 of Korean heritage and 69 non-Korean (77% White non-Hispanic/Latino, 10% Hispanic/Latino, 10% Black, 1.4% Asian, 1.4% Hawaiian/Pacific Islander) were evaluated. RT modality included 3DCRT (n=71, 54.2%), SBRT (n=47, 35.9%), and IMRT (n=13, 9.9%). The median RT dose delivered was 24 Gy (range 4-50). The Korean and non-Korean groups had a mean age of 71.2 and 62.7, respectively. The mean pain scores for pre- and post-RT were 6.1 ?1.4 for Koreans and 5.65?2.42 for non-Koreans. Korean patients were more likely to report a robust pain response compared to the non-Korean patients (p=0.039). However, after controlling for confounders such as gender, age, analgesic use, and RT modality, the difference was not statistically significant. Physician ethnic concordance did not affect pain scores. MLR identified age (p=0.048, OR 1.037) and pre-RT opioid use (p=0.025, OR 3.606) as predictors of robust pain response. Analgesic use for pre- and post-RT were 69.4%?36.2% for Koreans and 92.8%?72.5% for non-Koreans. Koreans were less likely to use non-opioids pre-RT (p<0.001), and both opioids (p<0.001) and non-opioids post-RT (p=0.007). Among those with robust pain response, Koreans were more likely to stop taking opioids (p<0.001) and non-opioids (p=0.007). Re-irradiation rates for Korean and non-Korean groups were 9.7% and 5.8%, respectively.
Conclusion: Korean patients are more likely to report a robust pain response to palliative RT to bone metastasis compared to non-Korean patients. While ethnicity alone was not a significant predictor of pain relief after adjusting for confounders, the observed differences in medication discontinuation patterns suggest a potential influence of cultural factors on pain management decisions. Further research should explore the intersection of ethnicity, cultural beliefs, and clinical strategies to improve personalized palliative care approaches.