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Study identifies racial disparities in multiple myeloma treatment, outcomes
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Outcomes for patients with multiple myeloma treatment appeared to substantially improve in recent years, according to findings published in Cancer.
However, racial disparities in treatment and management of the disease remain.
“Death rates [from multiple myeloma] have been falling over the last decade, with a reported 5-year survival rate of 48.5%,” Sikander Ailawadhi, MD, of the Mayo Clinic, and colleagues wrote. “This is mainly because of a rapidly improving therapeutic landscape with novel drugs, better understanding of disease biology and improvement in supportive care. Despite these encouraging trends, disparities exist in MM outcomes by patient race/ethnicity.”
The researchers used the SEER database to evaluate 35,842 patients diagnosed with multiple myeloma between 1991 and 2010. Ailawadhi and colleagues assessed racial trends in the receipt of treatment, cost of care, OS and clinical myeloma-defining events.
Overall, the frequency of myeloma-defining events rose over time; however, between 2006 and 2010, all events decreased except for renal dialysis.
Black patients had higher rates of myeloma-defining events in all categories except for bone fractures, where white patients demonstrated the highest rates.
Treatment increased over time, with rates of patients receiving any treatment, stem cell transplantation or multiple agents increasing significantly. The receipt of steroids and immunomodulatory drugs showed the largest increases.
Black and white patients received more stem cell transplantation and bortezomib than other racial or ethnic groups, whereas Asian and Hispanic patients received more immunomodulatory drugs (P < .001).
In the first 6 months following diagnosis, black patients filed the most Medicare claims, whereas Hispanics filed the most at any time after being diagnosed. Hispanics also showed the steadiest increase in Medicare claims over time (P < .001).
Factors such as hypercalcemia, bone fractures and renal dysfunction appeared linked with an inferior OS. Although black and Asian patients demonstrated a superior OS to white patients overall, racial disparities in OS shrank between 2006 and 2010 compared with earlier years.
Socioeconomic status also appeared to be a factor. Patients with higher median incomes tended to have better OS.
“Health care disparities across races have become an important focus, because they are linked with differential outcomes, and mitigating the factors that lead to these disparities is considered an important goal for health care equity,” Ailawadhi and colleagues wrote. “A better understanding and accounting for these factors will ensure that all patients, irrespective of sociodemographic factors, receive benefit from novel therapeutics, health care access and health care use.” – by Andy Polhamus
Disclosures: Ailawadhi reports grants from Pharmacyclics, Inc., as well as personal fees from Amgen, Novartis and Takeda, all outside the submitted work. No other authors report any relevant financial disclosures.
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