Multiple myeloma, race, insurance and treatment

Joshi, Himanshu; Lin, Sylvia; Fei, Kezhen; Renteria, Anne S.; Jacobs, Hannah; Mazumdar, Madhu; Jagannath, Sundar; Bickell, Nina A.

doi:10.1016/j.canep.2021.101974

Cited by 14 publications

(8 citation statements)

References 36 publications

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“…To minimize these biases, we excluded the SNPs associated with survival which were proxied by age at recruitment. Finally, our results only apply to European ethnicity due to limited access to other races, but race problems often contribute to the underuse of treatment and unplanned interruptions in MM treatment 50 …”

Section: Discussionmentioning

confidence: 95%

Causal relationships between inflammatory factors and multiple myeloma: A bidirectional Mendelian randomization study

Wang¹,

Shi²,

et al. 2022

Intl Journal of Cancer

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Changes in serum inflammatory factors occur throughout the onset and multiple myeloma (MM) progression, the feedback loops make it harder to distinguish between causes and effects. In the present study, we performed a bidirectional summary‐level Mendelian randomization (MR) analysis to elucidate the causal relationships of C‐reactive protein (CRP) and inflammatory regulators with MM. Summary‐level data of genetic variants associated with inflammation were extracted from two genome‐wide association studies (GWASs) on CRP and human cytokines, while data on MM was from large meta‐analyses of GWASs among 372 617 UK Biobank participants. The inverse‐variance weighted (IVW) method was used as the primary MR analysis and MR‐Egger, weighted median, and MR‐pleiotropy residual sum and outlier (MR‐PRESSO) were used as the sensitivity analyses. Our results suggested that higher levels of monocyte‐specific chemokine‐3 (IVW estimate odds ratio [ORIVW] per SD genetic cytokines change: 1.24; 95% confidence interval [CI]: 1.03‐1.49; P = .02), vascular endothelial growth factor (1.14, 1.03‐1.27; P = .02), interleukin‐10 (1.33, 1.01‐1.75; P = .04) and interleukin‐7 (1.24, 1.03‐1.48; P = .02) were associated with increased risk of MM, while lower levels of tumor necrosis factor‐β (0.84, 0.74‐0.92; P < .001) was strongly associated with an increased risk of MM. And conversely, genetically predicted MM was related to increased levels of interleukin‐17 (IVW estimate β: 0.051, 95% CI: 0.018‐0.085; P = 2.7 × 10−3). Besides, we observed no such significant associations for other inflammatory factors in our study. Overall, our study provides genetic evidence on the relationships of CRP and systemic inflammatory regulators with MM. Targeted interventions of specific inflammatory factors may have implications to alleviate MM cancer risk.

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Section: Discussionmentioning

confidence: 95%

Causal relationships between inflammatory factors and multiple myeloma: A bidirectional Mendelian randomization study

Wang¹,

Shi²,

et al. 2022

Intl Journal of Cancer

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“…Previous studies have documented a significant association of insurance with the underuse of maintenance therapy and with treatment interruptions. 11 In addition, financial toxicity is frequently reported even among insured patients with multiple myeloma. 30 Although having private insurance is generally regarded as a proxy for better access to medical care, out-of-pocket costs related to NDMM treatment can vary considerably in privately insured patients.…”

Section: Discussionmentioning

confidence: 99%

“…8 High costs of triplet and quadruplet treatment regimens and oral medications such as lenalidomide, as well as health insurance-related factors, may contribute to these treatment disparities, but evidence is conflicting. [9][10][11][12][13][14][15] Race-dependent disparities in multiple myeloma care have been documented. 16,17 Less is known about the relationship between insurance type, socioeconomic status, and NDMM treatment patterns.…”

Section: Introductionmentioning

confidence: 99%

Role of Patient Characteristics and Insurance Type in Newly Diagnosed Multiple Myeloma Care Disparities

Gasoyan,

Anwer,

Casacchia

et al. 2024

JCO Oncol Pract

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PURPOSE Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM). METHODS This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022. Multivariable logistic regression models examined associations of demographic/clinical characteristics and SDOH with care patterns. RESULTS We identified 569 patients with median age at diagnosis of 66 years (IQR, 59-73); 55% were male, 76% White, 23% Black, 1.1% other races, insured by Medicare (51%), private payer (38%), Medicaid (8.3%), and self-pay/other (1.8%). In the multivariable models, self-pay/other payers (adjusted odds ratio [AOR], 0.15 [95% CI, 0.03 to 0.54]) was associated with lower odds of triplet or quadruplet regimen, compared with Medicare. Private insurance (AOR, 0.48 [95% CI, 0.27 to 0.86]) and self-pay/other payers (AOR, 0.16 [95% CI, 0.04 to 0.74]) had lower odds of lenalidomide. Black patients ( v White; AOR, 0.47 [95% CI, 0.26 to 0.85]) and patients treated at regional hospitals ( v Taussig Cancer Center; AOR, 0.27 [95% CI, 0.12 to 0.57]) had lower odds of SCT. The odds of receiving triplet or quadruplet regimen, lenalidomide, and SCT also varied by the year of NDMM. CONCLUSION Care for NDMM varied based on race, insurance type, year of diagnosis, and treatment facility. It may be useful to examine the impact of insurance-related characteristics and recent policy initiatives on care disparities.

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“…Multiple myeloma (MM) is a malignancy of plasma cells and is the second most common hematologic malignancy representing 1% of all cancers in the United States [ 1 ] with an estimated 35,000 new cases diagnosed in the year 2022 and approximately 12,000 deaths [ 2 ]. Nationally, African Americans are more likely than Whites to be diagnosed with MM (15.7 vs. 7.7 per 100,000) and to die of MM (7.5 vs. 4.2 per 100,000) [ 1 ]. Hispanics are also diagnosed with MM at younger ages than Whites (65 years vs. 70 years) [ 3 ] and have lower median survival times (2.4 years vs. 2.6 years, p = 0.006) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

What Affects Treatment Underuse in Multiple Myeloma in the United States: A Qualitative Study

Cytryn

Bickell

Yagnik

et al. 2023

Cancers

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Background: Multiple myeloma (MM) is the second most common hematologic malignancy. African Americans are more likely than Whites to be diagnosed with and die of MM, but they experience the same survival times in clinical trials, suggesting that differences in survival may be attributed to differences in receipt of treatment or differences in access to new treatments. We undertook this study to identify the reasons and needs underlying disparities in treatment among patients diagnosed with MM. Methods: We conducted in-depth interviews in 2019–2020 with patients diagnosed with MM between 2010 and 2014 who were identified as eligible for transplant and maintenance therapy and having experienced delays in or underuse of treatment for MM. Underuse was defined as the lack of a particular treatment that the patient was eligible to receive, not being transplanted if eligible, and/or not receiving maintenance therapy. Underuse included patients’ decision to delay harvest or autologous stem cell transplant (ASCT) for the time being and return to the decision in the future. All interviews were audio-recorded and transcribed verbatim. Four investigators independently coded transcripts through inductive analysis to assess reasons for treatment decisions. Results: Of the 29 patients interviewed, 68% experienced treatment underuse: 21% self-identified as African American, 5% as Hispanic, 10% as mixed race, 57% as White, and 16% as Asian. There were no racial differences in reasons for underuse or delay. Themes relating to treatment underuse included: perceived pros and cons of treatment, including potential harm or lack thereof in delaying treatment; physician recommendations; and personal agency. Conclusion: Patients’ decision making, delays, and underuse of MM treatment are influenced by social, personal, medical, and contextual factors. Patients consider their relationship with their physician to be one of the most significant driving forces in their decisions and treatment plans.

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Multiple myeloma, race, insurance and treatment

Cited by 14 publications

References 36 publications

Causal relationships between inflammatory factors and multiple myeloma: A bidirectional Mendelian randomization study

Causal relationships between inflammatory factors and multiple myeloma: A bidirectional Mendelian randomization study

Role of Patient Characteristics and Insurance Type in Newly Diagnosed Multiple Myeloma Care Disparities

What Affects Treatment Underuse in Multiple Myeloma in the United States: A Qualitative Study

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