Cancer patients from minority ethnic backgrounds lose out on pain relief at end of life, study finds

In the first study of its kind in England, funded by the National Institute for Health and Care Research (NIHR), researchers from the Wolfson Palliative Research Centre, Hull York Medical School, University of Hull, in collaboration with King’s College London and Cambridge University, analysed the health records of more than 230,000 adults with cancer who died between 2011 and 2021.

They discovered that patients from Black, South Asian, mixed, and other ethnic backgrounds received fewer opioid prescriptions and lower doses of these pain-relieving medications than people from White backgrounds, even after accounting for patient age, cancer type, other health conditions and levels of deprivation.

Lead researcher Professor Jonathan Koffman, Professor of Palliative Care and Associate Director at the Wolfson Palliative Care Research Centre, said: “This is the first population-based study in England to examine the association between ethnicity and opioid prescribing for cancer pain in the last three months of life.

“Adequate pain relief is a human right. Up to 90 per cent of cancer patients experience pain as they near the end of life. Effective treatment matters not just for comfort, but for dignity, quality of life, and even survival. Opioid medicines have proved to be highly effective in managing pain.

“We found that people from minority ethnic backgrounds were less likely to receive prescriptions for opioids compared to those who are White. Among those prescribed opioids, the doses given were also lower.”

The study also showed that patients from minority ethnic backgrounds were more likely to have multiple emergency (A&E) department visits and multiple hospital admissions in their last three months of life, suggesting their pain may be under-treated in the community.

Professor Koffman said: “These are not locations people wish to be in their last three months of life. It is possible that inadequate prescribing of pain medicines for those from minority ethnic backgrounds in the community leads to crises that need to be managed in hospital.

“These findings underline the urgent need to understand and address inequities in pain relief and end-of-life care, ensuring that all patients receive appropriate and compassionate support regardless of ethnicity.

“Pain control at the end of life is not optional — it is a cornerstone of compassionate, high-quality care. To know that some groups of patients consistently receive less pain relief is both ethically indefensible and deeply concerning for health equity.”

Researchers suggest disparities in prescribing may be due to ethnic differences in preferences for opioids; fears of dependency and side effects; cultural or religious differences in the ways patients respond to illness and symptoms; or under-reporting of pain associated with the perceived social status of clinicians. Language barriers may impede the communication of pain history. Conscious or unconscious bias on the part of physicians may lead to assessments of pain differing from those of their patients.

The study reviewed primary care electronic health records, Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records and captured data on adults aged 18 and over who died between 2011 and 2021 with a cancer diagnosis and who had been prescribed an opioid in the last three months of their lives.

The Research is published in the British Journal of Cancer

Visit Wolfson Palliative Care Research Centre for further information.

Notes to editors:

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research by:

• funding high quality, timely research that benefits the NHS, public health and social care
• investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services
• partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research
• attracting, training and supporting the best researchers to tackle complex health and social care challenges
• collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system
• funding applied global health research and training to meet the needs of the poorest people in low and middle income countries

NIHR is funded by the Department of Health and Social Care.

NIHR’s work in low and middle income countries is principally funded through UK international development funding from the UK government.