This article is more than 5 years old. Information may no longer be current.
Sociodemographic factors influence survival of younger patients with multiple myeloma
Click Here to Manage Email Alerts
Marital status, insurance status and county-level income — but not race or ethnicity — significantly influenced OS among younger patients with multiple myeloma, according to results of a SEER analysis.
Treatment advances have prolonged OS among patients with multiple myeloma, but these improvements have occurred primarily in white patients rather than in ethnic minorities.
Luciano Costa
“Because of the complexity, length of duration, and high cost of these treatments, we hypothesized that sociodemographic factors, including insurance status, marital status, income, and educational level, may contribute to the OS observed in patients with multiple myeloma irrespective of race/ethnicity,” Luciano Costa, MD, PhD, associate professor of medicine in the Blood and Marrow Transplantation and Cell Therapy Program at University of Alabama at Birmingham, and colleagues wrote. “Although sociodemographic factors have been evaluated extensively in the more commonly occurring solid tumors, to the best of our knowledge the combined effects of sociodemographic factors on the OS observed in patients with multiple myeloma remains unclear, particularly among those diagnosed before age 65 years.”
Costa and colleagues used the SEER-18 database from 2007 to 2012 to identify 10,161 patients aged younger than 65 years at the time of their multiple myeloma diagnosis.
Median follow-up was 27 months (range, 0-71), representing 22,179 person-years.
Researchers assessed the following sociodemographic variables: marital status, insurance status, median household income and educational achievement in the county of residence.
Results of a multivariable analysis showed risk for death was associated with the SEER-18 registry (P = .001), age (HR for each additional year = 1.03; 95% CI, 1.02-1.04) and male sex (HR = 1.18; 95% CI, 1.1-1.28).
Researchers also identified three sociodemographic factors associated with a greater risk for death:
marital status (divorced, HR = 1.24; 95% CI, 1.11-1.39; single, HR = 1.39; 95% CI, 1.27-1.53; widowed, HR = 1.43; 95% CI, 1.2-1.71);
insurance status (Medicaid, HR = 1.76; 95% CI, 1.59-1.94; uninsured, HR = 1.43; 95% CI, 1.23-1.67); and
county level income (second lowest quartile, HR = 1.19; 95% CI, 1.03-1.37; lowest quartile, HR = 1.27; 95% CI, 1.09-1.49).
Patients with none of these sociodemographic factors demonstrated a 4-year OS rate of 71.1%. Conversely, rates of 4-year OS were 63.2% for patients with one of these factors, 53.4% for patients with two, and 46.5% for patients with three (P < .001).
Hispanic, non-Hispanic black, and other race and ethnicity were associated with increased risk for death in a crude analysis; however, after adjusting for marital status, insurance status, county-level household income, sex and age, race and ethnicity were not significantly associated with risk for death. This suggests “the apparent impact of race/ethnicity on OS may be due to the disparate distribution of sociodemographic factors observed among the different race/ethnicities rather than the race/ethnicity construct itself,” the researchers wrote.
Researchers acknowledged that they did not have data on disease-specific factors, treatment and treatment responses, which could have limited these findings.
“This finding strongly suggests that there is a huge disparity in outcomes that could potentially be overcome by improving access and affordability of treatments,” Costa said in a press release. “With the recent emphasis on comparative effectiveness in oncology, it also becomes crucial that all variables affecting outcomes — including sociodemographic factors — are accounted for when comparisons between different therapeutic approaches and health care systems are made.” – by Alexandra Todak
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Joseph Mikhael
Costa and colleagues raise an important issue in cancer care — the connection between certain sociodemographic factors and survival in cancer. This is particularly important in multiple myeloma, a disease with an incidence nearly twice as high in the African American population than in white individuals. Four factors were evaluated for their association with decreased survival. Three of those — marital status, insurance status, county-level income — were associated with decreased survival. Race/ethnicity was not associated with survival.
These findings are hypothesis generating and warrant further investigation. In a day when myeloma therapies are most costly to the patient and may require more caregiver support, these factors are important.
However, as a SEER database study, the lack of the treatment approach makes it hard to draw deep conclusions. Further, the ethnicity equivalence is not necessarily a reassurance that there are not access issues, biological differences between populations with this disease or that we need not remain vigilant to provide outstanding care to all patients independent of race/ethnicity.
Disclosure: Mikhael reports no relevant financial disclosures.
Click Here to Manage Email Alerts