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Socioeconomic factors linked to multiple myeloma survival
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CHICAGO — Having private insurance, living in a higher-income region and receiving treatment at an academic institution all appeared associated with significantly longer OS for patients with multiple myeloma, according to study results presented at ASCO Annual Meeting.
The affordability of oral antineoplastics (OAM), a notoriously expensive class of drugs often used to treat multiple myeloma, may be linked to the disparity in outcomes, researchers noted. OAM prices have risen rapidly in the past several years.
“The outcome for patients with multiple myeloma has dramatically improved over the last 30 years [due to] the increased use of novel agents and autologous stem cell transplants,” Kamal Chamoun, MD, fellow in stem cell transplant and cellular therapy at University Hospitals of Case Western Reserve University in Cleveland, said during the presentation. “However, this has come with financial toxicities for patients. Multiple myeloma is now the No. 1 cancer treated with oral anticancer medications and these are often very expensive. Studies have shown that the treatment costs have nearly tripled between 2000 and 2014.”
Chamoun and colleagues analyzed data from the National Cancer Database on 117,926 patients (median age at diagnosis, 67 years; range, 19-90; 55% men; 76% white) diagnosed with multiple myeloma between 2005 and 2014 to test their hypothesis that insurance status influenced multiple myeloma survival.
A majority of the patients (57%) lived in areas with median incomes of less than $46,000 per year. Primary insurance included Medicare (54%; median age, 74 years), private insurance (36%; median age, 57 years) and Medicaid (6%; median age, 58 years). Three percent of patients (median age, 57 years) had no insurance. Less than half (40%) of all patients were treated at an academic institution.
OS served as the study’s primary endpoint.
After a median follow-up of 30 months (range, 0-145), results of a multivariate analysis showed that OS was significantly worse among patients treated at other hospital types vs. at academic institutions (HR = 1.49; 95% CI, 1.39-1.59) and those with a lower vs. higher median regional income (< 46k vs. 46k; HR = 1.16; 95% CI, 1.08-1.25).
Compared with patients with private insurance, researchers observed poorer outcomes among those with Medicare (HR = 1.09; 95% CI, 0.99-1.2), Medicaid (HR = 1.59; 95% CI, 1.36-1.87) or no insurance (HR = 1.62; 95% CI, 1.32-1.99).
When the analysis was limited to patients aged 65 years or older, patients with private insurance appeared to live significantly longer than those with Medicare (median, 41.9 months; 95% CI, 40.1-43.6vs. 30.8 months; 95% CI, 30.3-31.3; P < .0001).
Researchers also found improved survival among patients with lower Charlson comorbidity scores (0 vs. 3; HR = 0.48; 95% CI, 0.39-0.59).
In analyses adjusted for age gender, primary vs. secondary tumor, Charlson score, income and hospital type showed no survival difference between white and black patients (period 2011-2014, median OS 52.9 months for white patients vs. 60.3 months for black patients; HR = 1.04; 95% CI, 0.95-1.14).
“When we look at a multivariate analysis accounting for age, gender, race, primary vs. secondary disease, comorbidities, hospital type, ZIP code-based median income and insurance type, we see that patients from areas with higher median ZIP code and patients treated in an academic setting had survival benefits,” Chamoun said. “Older age and comorbidities adversely affected survival, and privately insured patients did better than those on Medicaid or without insurance.” – by John DeRosier
Reference:
Chamoun K, et al. Abstract LBA107. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.
Disclosures: Chamoun reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
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Afsaneh Barzi, MD
Chamoun and colleagues showed disparities in multiple myeloma outcomes by patients’ insurance and socioeconomic status and where they get treatment. This is nothing new for cancer care. Generally, uninsured patients or patients on Medicaid do worse than patients with other insurance types. In other cancers, it’s well-known that insurance type and socioeconomic status are independent predictors of outcome.
Patients on Medicaid or patients who are uninsured usually have the poorest outcomes in the majority of malignancies. So this is not a surprise, but it’s new for multiple myeloma.
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