Disparities in Treatment Initiation Among Patients With Multiple Myeloma
Posted: Monday, March 23, 2020
Although the past 20 years have seen substantial advances in multiple myeloma treatment, a recent study published in JCO Oncology Practice suggested that adjusting the timing of treatment initiation in patients with multiple myeloma may improve survival outcomes even more. Vivek Kumar, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues found that existing disparities among groups of patients affected the timing of treatment initiation—including race, sex, age, year of diagnosis, insurance status, and the location of treatment.
Using the National Cancer Database, the research team retrospectively analyzed disparities and trends in the timing of treatment among patients with multiple myeloma. The analysis included patients who were diagnosed between 2004 and 2015.
The researchers observed several disparities in treatment timeliness. For example, the initiation of myeloma treatment was delayed more among women and black patients than among men. In addition, patients who were diagnosed between 2012 and 2015 were delayed more than those diagnosed between 2004 and 2007. The investigators observed a small but statistically significant association between farther distance from treatment facilities and later start to therapy for multiple myeloma. Patients who were more likely to initiate treatment earlier were those who were aged 80 or older, uninsured, or used Medicaid. If patients were treated at a comprehensive community cancer program, lived in a location other than the Northeast United States, or had a higher Charlson comorbidity score, they were also more likely to receive earlier treatment. Income and education levels did not appear to affect the time to treatment initiation.
“Particular aspects of these disparities could be explained by our current health-care system and insurance rules, whereas others need to be investigated more deeply,” the researchers concluded.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.