Older patients and those with poorer overall health are not as likely to receive treatment for multiple myeloma (MM), despite the fact that MM is most commonly a disease of older individuals, with a median age of diagnosis of 66 years.
“With the expanding armamentarium of therapeutic agents for multiple myeloma, it is important to identify any untreated or undertreated patient populations,” said Bita Fakhri, MD, MPH, Department of Medicine, Divisions of Hematology and Oncology, Washigton University School of Medicine in St. Louis, MO. She presented the results of a retrospective analysis of patients with MM n the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database at the 58th American Society of Hematology Annual Meeting and Exposition in San Diego, CA.
Study authors analyzed data from 2,650 patients, collecting all MM cases from the SEER-Medicare database from 2007–2011 using ICD-9 code 203.0 (MM and immunoproliferative neoplasms). Patients—whose median age was 75 years old and were mostly Caucasion (77%) females (52%)—were included in the study if they had been continuously enrolled in Medicare Part A, B, or D starting the year prior to diagnosis.
Researchers used the diagnosis and procedure codes for the administration of MM agents to distinguish patients who received treatment versus those who did not. Multivariate logistic regression was completed to identify the variables that were independently related to receiving treatment.
The results showed a number of trends that pointed to disparities in treatment. Among the 2,650 patients with active MM, 839 (32%) did not have any systemic treatment. Moreover, “older age, poor performance indicators, comorbidities, African American background, and a lower socioeconomic status (SES) were statistically significant factors associated with receipt of no systemic treatment,” Fakhri said.
Risk of not receiving treatment was higher in several ways.
- For every year of age, the risk of not receiving MM agents increased by 4%.
- Patients of African American descent had a higher risk of not receiving treatment of 28%.
- For every $10,000 increase in median household income, the likelihood of receiving treatment increased by 4%.
“We found that age, health status, race, and SES were predictive of receiving treatment for MM. These factors have previously been linked to reduced utilization of specific treatments for MM, such as stem cell transplants. But, to our knowledge, this is the first study to show their association with the receipt of any MM therapy,” the presenters said. “Given the advances in MM treatment in the past two decades, many with a more favorable toxicity profile compared to conventional chemotherapy, it is critical to investigate and address the barriers to treatment in patients who are less likely to receive the life-prolonging drugs.”