Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma

Abstract

Background Disparities driven by socioeconomic factors have been shown to impact outcomes for cancer patients. We sought to explore this relationship among patients with multiple myeloma (MM) who were not considered for hematopoietic stem cell transplant in the first-line setting and how it varied over time. Methods We queried the National Cancer Database for patients diagnosed with MM between 2004 and 2016 and included only those who received systemic therapy as the first-line treatment. Enrollment rates for therapy were calculated as receipt of systemic therapy as the incident event of interest (numerator) over time to initiation of therapy (denominator) and used to calculate incident rate ratios that were further analyzed using Poisson regression analysis. A multivariate Cox proportional hazards model was constructed for survival analysis, and differences were reported as hazard ratios (HRs). Results We identified 56,102 patients for enrollment analysis and 50,543 patients for survival analysis. Therapy enrollment in a multivariate model was significantly impacted by race and sex ( p < .005). Advanced age, earlier year of diagnosis, lack of insurance or Medicaid, and higher comorbidity were associated with poor survival (HR > 1), whereas female sex, non-Hispanic black race, higher income, and treatment at an academic center were associated with improved survival (HR < 1). Conclusion Disparities in treatment of MM exist and are caused by a complex interplay of multiple factors, with socioeconomic factor playing a significant role. Studies exploring such determinants may help in equitable distribution of resources to overcome such differences.

Cancer statistics for African American/Black People 2022

“…115,119,120 Indeed, Black people have benefited less from recent treatment advancements because of less access to care, including lower utilization of the most recent treatment advances and more delays in treatment. 115,121…”

“…The somewhat higher contemporary survival among Black people may reflect a lower prevalence of aggressive disease subtypes 115,119,120 . Indeed, Black people have benefited less from recent treatment advancements because of less access to care, including lower utilization of the most recent treatment advances and more delays in treatment 115,121 …”

Comparison of clinical characteristics, efficacy and survival of newly diagnosed extramedullary multiple myeloma patients between single and multiple sites invasion

“…Guillermo CL et al reported that male sex was one of predictive factors for early mortality of multiple myeloma patients (Guillermo CL et al 2007). Other studies also con rmed the association of female gender with improved survival (Jayakrishnan TT et al 2021;Ikeda T et al 2019). But in another study, female gender was con rmed to be associated with inferior overall survival (44.8 months vs. 49.9 months, P = 0.020) (Boyd KD et al 2011).…”

Impact of academic medical center access on outcomes in multiple myeloma

“…As such, we cannot fully determine how the staging and aggressiveness of disease differ between facilities, which may greatly impact survival differences. The lack of complete transplant data is a particularly large limitation, as this is an intervention that is generally unavailable at small community hospitals and is well established to benefit MM patients 9,35 . This may lead to significant selective pressure on facility selection for eligible patients.…”