Pain-Related Disparities in Healthcare Expenditures Among Adults with Cancer in the United States: Evidence from the Medical Expenditure Panel Survey (2019-2022).

Background: Cancer-related pain is a common and debilitating symptom that reduces quality of life and increases healthcare utilization. While prior studies have examined pain in specific cancer populations, its national economic impact remains understudied. Objective: To estimate pain prevalence among US adults with cancer, evaluate differences in healthcare expenditures by pain status, and identify drivers of these disparities, with the aim of informing value-based cancer care and pain management policies. Methods: We analyzed 4368 adults with cancer from the 2019-2022 Medical Expenditure Panel Survey (MEPS). Pain defined as self-reported interference with normal activities in the past four weeks. Total healthcare expenditures including: inpatient, outpatient, prescription, emergency, and other costs were examined using generalized linear models, adjusting for demographic, socioeconomic, and clinical factors. Blinder-Oaxaca decomposition quantified contributions of observed and unobserved factors to expenditure differences. Results: Pain was reported by 55% of adults with cancer. Unadjusted mean expenditures were higher for patients with pain ($22,072) versus those without ($13,366; p < 0.0001). Adjusted analyses indicated pain was associated with an incremental total cost of $4473 (p = 0.001), mainly driven by inpatient ($2002; p = 0.001), prescription ($1711; p = 0.045), and outpatient costs ($1347; p = 0.003). Decomposition analysis showed 64% of the expenditure difference was explained by observed factors particularly self-reported health and comorbidities, while 36% remained unexplained, suggesting gaps in pain assessment, care quality, or access to effective management strategies. Pain prevalence and associated costs were higher among older adults, socioeconomically disadvantaged individuals, and those with multiple chronic conditions. Conclusion: Pain places a substantial economic burden on adults with cancer, with disparities influenced by both clinical and socioeconomic factors. Implementing systematic pain assessment and management, including patient-reported outcomes and multimodal interventions, may support cost containment, improve outcomes, and advance value-based oncology care. Policy efforts should prioritize equitable access to comprehensive pain management and integration of pain metrics into cancer care quality frameworks and reimbursement models.