Underutilization of guideline‐recommended supportive care among older adults with multiple myeloma in the United States

Abstract

Background With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment‐related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown. Methods This study used the Surveillance, Epidemiology, and End Results–Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008‐2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline‐recommended supportive care, which was defined as 1) bone‐modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility‐level characteristics and supportive care use. Results Among 1996 patients receiving MM‐directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non‐Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46‐0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34‐0.54) had lower odds of BMDs. Non‐Hispanic blacks (OR, 0.52; 95% CI, 0.37‐0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58‐0.99) had lower odds of influenza vaccination. Treatment in a community‐based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46‐0.72). Conclusions Substantial underutilization of guideline‐recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM.

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

“…For example, age, race/ethnicity, sex, and comorbidities have also been associated with receipt of supportive care and symptom management medications among Medicare beneficiaries with cancer in other settings. [12][13][14] In addition, out-of-pocket costs for medications may create barriers to care. Under the hospice benefit, a bundled payment fully covers all symptom management medications and services.…”

Impact of academic medical center access on outcomes in multiple myeloma

“…While NCI‐CCCs provide a significant benefit in research and funding, all ACs are characterized by their access to research and specialized providers. All categories of ACs also share high patient volumes, improved supportive care, and access to specialized treatments over other facility types 8,11 . Access to autologous stem cell transplant, which is the standard of care in eligible MM patients, is also generally only available at ACs, and many of our patients may either be selected for ACs treatment due to transplant eligibility, or benefiting from early access to transplant 9 …”

“…Patients have greater access to such measures at the Commission on Cancer (CoC) accredited academic cancer centers (ACs), which are defined by the availability of MM specialists, access to comprehensive cancer treatment, and high patient volume, which has previously been shown to be independently associated with improved survival in MM 5–7 . In addition to high volume subspecialist oncologists, ACs also offer increased access to clinical trials, stem cell transplant, and large and integrated supportive care structures not available at many other facilities 8–12 …”

Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma

“…For example, organizational hurdles and patients preference may jeopardize guidelines adherence. A recent analysis of the "Surveillance, Epidemiology, and End Results-Medicare" database (https://seer.cancer.gov/, accessed on 4 October 2021) showed that only 64% of older adults with active MM received bonemodifying agents, 52% an influenza vaccination, and less than 50% antiviral prophylaxis during treatment with PI [144]. Similarly, a French study reported very low rates of vaccination for influenza (28%) in MM patients, with less than 1% of the patients receiving all three recommended vaccines (influenza, Streptococcus pneumoniae, and Hemophilus influenzae) [145].…”