Interventions ‘moving in the right direction’ in multiple myeloma racial disparities
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The racial disparities that exist in the treatment and management of patients with multiple myeloma have been examined and charted for years, even decades.
It is known that Black individuals are two times more likely to be diagnosed with myeloma compared with white individuals. In addition, Black patients with multiple myeloma appear to experience worse overall outcomes compared with their white counterparts.
“When looking at the overall U.S. population, approximately 12% of the population is Black whereas 20% of the multiple myeloma population is Black — there is more than a fair share of Black patients with multiple myeloma in this country,” Ajay K. Nooka, MD, MPH, FACP, associate professor of hematology and medical oncology at Emory School of Medicine, said during an interview with Healio. “However, survival outcomes among Black patients with multiple myeloma have improved according to population-based studies. Compared with white patients, [Black patients] present with multiple myeloma at a much younger age and without high-risk features that are known to be associated with worse outcomes among [white patients].”
In addition, the treatment advances within the past 2 decades have helped shrink the disparities gap among Black and white patients.
Historical gaps in care
Multiple factors can be linked to the disparities gap in care for patients with multiple myeloma.
“The biology of the disease differs significantly between Black [patients] and white [patients], access to care varies and is a significant issue, including those with low socioeconomic status and low levels of education,” Nooka said. “Mistrust in the medical system is another significant factor, especially among Black [individuals] and this is very clear in the clinical trial setting.”
While the proportion of Black patients with multiple myeloma is approximately 20%, only 5% are enrolled on a clinical trial, Nooka added.
“The biggest reason for this is that many Black patients do not believe that clinical trials are of their best interest. Mistrust in the medical system continues to persist and it is difficult to enroll a Black patient on a clinical trial for this reason. Consequently, this contributes to inferior survival outcomes observed among the Black population because clinical trials examine newer targeted agents, but Black patients do not have access to these agents because they are not enrolling on clinical trials. This contributes, at least partially, to the differences in survival outcomes that we see.”
New recommendations published in Blood Cancer Discovery in February address the underrepresentation of Black patients in cancer clinical trials.
The guideline, which stemmed from an FDA and American Association for Cancer Research workshop aims to eliminate racial bias by including more Black patients in clinical trials and support the use of real-world data to examine the effects of antimyeloma agents among this population.
“We have made the most headway in first recognizing that there is a significant problem — interventions can only be created when we see that a problem exists in the first place,” Nooka said. “Organizations have come together to understand that this is a huge problem that we need to deal with. Six months after the meeting held by the FDA and AACR, the industry made an impact on clinical trial enrollment. For the first time ever, I saw a clinical trial that stated: ‘Our population should have representation of the patient demographic.’ This means that between 15% and 20% of the patients enrolled on that multiple myeloma clinical trial should be Black — this is a huge advancement. We have never seen this stated before. Industry-sponsored trials have also, for the first time-ever, adopted this. This is a huge step in the right direction.”
ASCO and other organizations have also made strides in reducing racial disparities in clinical trial participation.
“When looking at the workforce who treat multiple myeloma patients and enroll them on clinical trials, the workforce is not representative of the patient population,” Nooka said. “There is now a huge push toward expanding the workforce to be more inclusive of the patient population that we serve. We tend to gain trust when health care providers look like patients and there is truth to this. Data on this has been published from multiple studies in the past. We are finally moving in the right direction in terms of realizing that this is a problem and developing interventions to address these problems.”
Impact of COVID-19
Unfortunately, the headway made on improving access to care among Black patients with multiple myeloma has been hindered by the COVID-19 pandemic.
“The communities that have been impacted the most during each surge of COVID-19 in the United States are the underrepresented groups,” Nooka said.
Nooka said he and colleagues continue to face challenges in providing care and treatments for their patients with multiple myeloma because of the COVID-19 pandemic.
“Most of the medications that we have, except for a few, are given intravenously or subcutaneously, which means patients have to come into the infusion center or hospital to receive their treatment,” Nooka said. “This makes it difficult for a person that is immunocompromised and places them at higher risk for acquiring COVID-19. However, one of the good things that has happened during the past year and a half is that we have not seen a huge surge in nosocomial infections. So, it is safe for patients to receive these treatments in the clinic or hospital setting. This shows that we are doing something right in terms of keeping our patients safe and our staff safe and has helped us provide care in the best optimal way for our patients with multiple myeloma.”
Regarding other treatment types, such as oral medications, in-office patient visits can be safely minimized, Nooka added.
“For patients with established disease stability, we began seeing them once every 2 to 3 months instead of once per month. We also call patients on the phone to check in on them and/or conduct virtual visits. All these interventions have helped us to make sure that our patients are kept safe,” Nooka said. “With this being said, we believe we are moving in the right direction from a disparities perspective. We understand the problem and have implemented interventions. Soon, these interventions will help us to evaluate whether we truly are moving in the right direction.”
Reference :
- Gormley N, et al. Blood Cancer Discov. 2021;doi:10.1158/2643-3230.BCD-20-0123.
For more information:
Ajay K. Nooka, MD, MPH, FACP, can be reached at anooka@emory.edu.
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