This article is more than 5 years old. Information may no longer be current.
Racial disparities seen in supportive care use among patients with multiple myeloma
Click Here to Manage Email Alerts
SAN DIEGO — Elderly adults with multiple myeloma in the U.S. did not fully utilize available supportive care measures aimed at bone health and infection prevention, with significant racial disparities seen in the receipt of this care, according to study results presented at ASH Annual Meeting and Exposition.
“’Patients with multiple myeloma are living longer than before, and it has become more relevant to focus on quality-of-life issues such as minimizing disease-related adverse events and toxic effects of therapy,” Smith Giri, MBBS, clinical fellow in Yale Cancer Outcomes, Public Policy and Effectiveness Research Center and section of hematology at Yale University School of Medicine, told HemOnc Today. “Various supportive care measures focused on bone health and infection prevention that have been shown to be safe and effective are uniformly recommended. Despite these recommendations, the extent to which these get adopted in real-world clinical practice remains unknown.”
Giri and colleagues consulted the SEER database to identify 1,569 Medicare beneficiaries aged older than age 65 years (median age, 74 years; 47% men; 73% non-Hispanic white) diagnosed with multiple myeloma between 2008 and 2013.
Researchers sought to determine the percentage of patients receiving guideline-consistent supportive care treatment, defined as: bisphosphonate treatment (zoledronic acid or pamidronic acid) within the first 12 months of diagnosis; receipt of influenza vaccine in the first flu season after diagnosis; and treatment with antivirals (acyclovir and valacyclovir) in patients undergoing bortezomib therapy.
The researchers evaluated possible predictors of supportive care utilization, including patient characteristics (age, gender, race/ethnicity, comorbidities, disabilities, diagnosis of chronic kidney disease, socioeconomic status, and year of diagnosis); provider volume/experience (number of multiple myeloma patients treated at a 12-month review); and type of facility (hospital outpatient vs. community setting).
Results showed only 66% of Medicare patients on active treatment for multiple myeloma received bisphosphonates within 1 year of diagnosis. During the first flu season after diagnosis, 53% of patients were vaccinated against influenza, and 44% received preventive antivirals while receiving bortezomib.
In a sensitivity analysis, researchers found that 48% of patients with preexisting chronic kidney disease received bisphosphonates, whereas 72% without preexisting chronic kidney disease received bisphosphonates.
Multivariable analysis revealed that the predictors of bisphosphonate nonuse included advanced age (OR for 85+ years vs. 66-69 years = 0.37; 95% CI, 0.23-0.58), non-Hispanic black (OR = 0.51; 95% CI, 0.34-0.76) and Hispanic ethnicity (OR = 0.56; 95% CI, 0.35-0.91), and elevated comorbidity index (Elixhauser index of 3+ vs. 0, OR = 0.41; 95% CI, 0.29-0.57).
Significant predictors of flu shot nonuse included non-Hispanic black ethnicity (OR = 0.49; 95% CI, 0.34-0.7) residence in the West vs. Midwest (OR = 0.54; 95% CI, 0.38-0.75), possession of Medicaid dual coverage (OR = 0.66; 95% CI, 0.49-0.89), and lower comorbidity score (Elixhauser index of 3+ vs. 0, OR = 1.44; 95% CI, 1.07-1.93).
Predictors of antiviral prophylaxis nonuse included earlier years of diagnosis (global P < .01, with increasing OR for later years) and higher comorbidity index (for Elixhauser index of 3+ vs. 0, OR = 0.4; 95% CI, 0.24-.0.67).
“We can learn from our study that making guidelines alone is not enough,” Giri told HemOnc Today. “Various strategies need to be implemented to ensure that these supportive care measures actually get adopted in routine clinical practice. Incorporating these measures into quality metrics, development of decision support tools, and other interventions focused on high-risk patients may help minimize these disparities in the future.” – by Jennifer Byrne
Reference:
Giri S, et al. Abstract 978. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego
Disclosures : Giri reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.