1. PAIN CONTROL AMONG CANCER SURVIVORS IN OHIO 2010 Robert W. Indian, Chief Mary Lynn, Researcher Debbie Wallace, Administrative Assistant Comprehensive Cancer Control Program Office of Healthy Ohio Ohio Department of Health Presented at: 2011 CDC National Comprehensive Cancer Project Directors’ Conference May 3-5, Atlanta, Georgia

2. INTRODUCTION: The Core Values and Goals of Medicine Emphasize the Relief of Pain and Suffering as a Pre-eminent Responsibility of Physicians. Pain Management Presents a Glaring Example of Disparity Between the Current State of Medical Knowledge and the Prevailing Custom of Medical Practice. Source: Ben Rich, PhD, J.D. “An Ethnical Analysis of the Barriers to Effective Pain Management”, 2009.

3. OBJECTIVE: Provide a Reliable Estimate of the Prevalence of Pain and Pain Control Among Ohio Cancer Patients Age 19 Years and Older.

4. METHODS Data Source: “Cancer Survivorship” Module in 2010 Ohio Behavioral Risk Factor Survey. Focus on Question: “Do you currently have physical pain caused by your cancer or cancer treatment?”

5. METHODS (cont’d) Prevalence Percentages and 95% Confidence Intervals (CIs) Calculate Using SAS version 9.2 (SAS Institute, Inc., Cary, North Carolina) Cross Tabulated by Gender, Age, Cancer Site/Type, Insurance Status, Type of Physician, Participation in Clinical Trial, and Receiving Instructions on Where to Go for Follow-up Care.

6. RESULTS: SAMPLE 2010 Ohio Total Sample: 9,857 Persons Age 19 and Older. 2010 “Ever Been Diagnosed With Cancer”: 1,107 (11.2%)

7. RESULTS: GENDER Current Cancer Pain GenderEst. Percent95% C.I. Male4.9%1.4 – 8.5 Female11.7%8.5 – 14.9 Total9.1%6.7 – 11.5 Conclusions: Females More Likely to Experience Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

8. RESULTS: AGE Current Cancer Pain Age Group (years)Estimate Percent (%)95% CI 18-4411.8%4.2-19.4 45-5415.1%6.5-23.6 55-6411.5%6.1-16.8 65 and older5.2%2.9-7.5 Conclusion: Cancer Survivors Age 65 and Older Less Likely to Report Current Cancer Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

9. RESULTS: CANCER SITE/TYPE CURRENT CANCER PAIN Cancer Type/SiteEstimated Prevalence95% CI Breast15.4%8.9-22.0 Cervical12.2%3.1-21.4 Colorectal9.3%2.1-16.4 Prostate6.9%0.0-14.9 Melanoma0.5%0.0-1.3 Other Skin1.5%0.0-3.2 Conclusion: Breast Cancer Survivors Most Likely to Report Current Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

10. RESULTS: INSURANCE STATUS CURRENT CANCER PAIN Insurance StatusEstimated Prevalence 95% C.I. Had Health Insurance8.6% 6.2-11.1 No Health Insurance19.6% 5.9-33.2 Conclusion: Persons without Health Insurance More Likely to Report Current Cancer Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

11. RESULTS: PHYSICIAN TYPE CURRENT CANCER PAIN Physician TypeEstimated Prevalence (%)95% CI Cancer Specialist16.7%7.1-26.3 Family Practice7.5%4.8-10.2 Internist5.8%1.4-10.2 Other11.2%4.4-18.0 Conclusion: Cancer Survivors still in Contact with Cancer Specialist Most Likely to Report Current Cancer Pain Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

12. RESULTS: PARTICIPATED IN CLINICAL TRIAL CURRENT CANCER PAIN Participation InEstimated Clinical TrialPrevalence%C.I. Yes20.1%1.5-38.7 No7.8%5.7-9.9 Conclusion: The Survivors Reporting Having Participated In a Clinical Trial Were More Likely to Report Current Cancer Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

13. RESULTS: RECEIVED FOLLOW-UP INSTRUCTIONS CURRENT CANCER PAIN Received Follow-UpEstimated InstructionsPrevalence95% CI Yes11.5%8.1-14.9 No4.4%1.7-7.1 Conclusion: Those Survivors Receiving Follow-up Instructions Reported More Current Cancer Pain. Source: 2010 Ohio BRFSS; Comprehensive Cancer Control Program; Office of Healthy Ohio, Ohio Department of Health.

14. DISCUSSION/LIMITATIONS Self Reported Data Small Sample Sizes/Large Confidence Intervals Could Benefit from Meta-Analysis

15. MANY THANKS American Cancer Society - $$ Funding $$ Ohio Behavioral Risk Factor Surveillance System – Inclusion of Cancer Survival Module Constantino Benedetti, M.D., The Ohio State University Medical Center – Inspiration and Dedication to Pain Control for Cancer Patients

16. QUESTIONS? Robert W. Indian, M.S. Chief, Comprehensive Cancer Control Program Bureau of Health Promotion and Risk Reduction Office of Healthy Ohio Ohio Department of Health 246 N. High Street Columbus, Ohio 43215 (614) 752-2464 Robert.Indian@odh.ohio.gov