Racial Disparities in Cost of Care, Outcomes for Medicare Patients With Myeloma

01/29/18

Despite significant treatment advancements in the management of multiple myeloma over the last 20 years, racial disparities in health care access and survival continue to exist, according to a report published in Cancer (online January 23, 2018; doi:10.1002/cncr.31237).

Since the 1990s, treatment advancements have significantly improved outcomes in multiple myeloma. However, racial disparities in health care access and survival continue to exist, and a comprehensive analysis evaluating multiple myeloma care and racial disparities is warranted.

Sikander Ailawadhi, MD, division of hematology-oncology, Mayo Clinic (Jacksonville, FL), and colleagues searched the Surveillance, Epidemiology, and End Results-Medicare database for patients with multiple myeloma from 1991 to 2010 (n = 35,842). Researchers evaluated for racial trends in clinical myeloma-defining events, receipt of treatment (drugs and stem cell transplantation), cost of care, and overall survival (OS).

Results of the study showed that the frequency of all myeloma-defining events increased over the study time span. In recent years (2006-2010), all myeloma-defining events with the exception of renal dialysis decreased.

Black patients had the highest rates for all myeloma-defining events with the exception of bone fractures, which were highest in white patients.

The proportion of patients who received any treatment, multiple myeloma-specific agents, and stem cell transplantation increased significantly from 1991 to 2010. The largest increase was observed in receipt of immunomodulatory drugs and steroids. Researchers noted that there was greater receipt of bortezomib and stem cell transplantation among white and black patients and higher receipt of immunomodulatory drugs among Hispanic and Asian patients (P < .001).

Dr Ailawadhi and colleagues noted that Medicare claims were highest during the first 6 months after multiple myeloma diagnosis for black patients and at any time after diagnosis for Hispanic patients. Over the course of the study period, Medicare claims increased most consistently for Hispanic patients (P < .001).

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Superior OS was observed among patients who had higher median outcomes and in black and Asian patients (racial differences became less pronounced during 2006 through 2010 [P = .182]). Among the factors associated with inferior OS were hypercalcemia, renal dysfunction, and bone fractures.

Authors of the study wrote that these findings provide and in-depth understanding of the factors that may help explain racial disparities in Medicare patients with multiple myeloma.—Zachary Bessette