1
|
Ailawadhi S, Adu Y, Frank RD, Das S, Hodge DO, Fernandez A, Flott C, Elliott J, Parrondo R, Sher T, Roy V, Chanan-Khan AA. Factors determining utilization of stem cell transplant for initial therapy of multiple myeloma by patient race: exploring intra-racial healthcare disparities. Blood Cancer J 2024; 14:86. [PMID: 38806475 PMCID: PMC11133435 DOI: 10.1038/s41408-024-01067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
Multiple myeloma (MM) therapeutics have evolved tremendously in recent years, with significant improvement in patient outcomes. As newer treatment options are developed, stem cell transplant (SCT) remains an important modality that provides excellent disease control and delays the progression of disease. Over the years, SCT use has increased overall in the U.S., but two distinct gaps remain, including suboptimal use overall and racial-ethnic disparities. We evaluated the National Cancer Database (NCDB) to study what sociodemographic factors might play a role within a given racial-ethnic group leading to disparate SCT utilization, such that targeted approaches can be developed to optimize SCT use for all. In nearly 112,000 cases belonging to mutually exclusive categories of non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, non-Hispanic Asians (NHA), and others, we found certain factors including age, comorbidity index, payor type, facility type (academic vs. community) and facility volume to be uniformly associated with SCT use for all the racial-ethnic groups, while gender was not significant for any of the groups. There were several other factors that had a differential impact on SCT utilization among the various race-ethnicity groups studied, including year of diagnosis (significant for NHW, NHB, and Hispanics), income level (significant for NHW and Hispanics), literacy level (significant for NHW and NHB), and geographic location of the treatment facility (significant for NHW and NHA). The suboptimal SCT utilization overall in the U.S. suggests that there may be room for improvement for all, even including the majority NHW, while we continue to work on factors that lead to disparities for the traditionally underserved populations. This study helps identify sociodemographic factors that may play a role specifically in each group and paves the way to devise targeted solutions such that resource utilization and impact can be maximized.
Collapse
Affiliation(s)
| | - Yaw Adu
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Saurav Das
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - David O Hodge
- Department of Health Sciences Research/Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Andre Fernandez
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Caitlyn Flott
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jamie Elliott
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo Parrondo
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | |
Collapse
|
2
|
Liu J, Liu W, Mi L, Cai C, Gong T, Ma J, Wang L. Burden of multiple myeloma in China: an analysis of the Global Burden of Disease, Injuries, and Risk Factors Study 2019. Chin Med J (Engl) 2023; 136:2834-2838. [PMID: 37075767 PMCID: PMC10686588 DOI: 10.1097/cm9.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma (MM) in China; therefore, this study determined the characteristics of the disease burden of MM at national and provincial levels in China. METHODS The burden of MM, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with a 95% uncertainty interval (UI), was determined in China following the general analytical strategy used in the Global Burden of Disease, Injuries, and Risk Factors Study 2019. The trends in the burden of MM from 1990 to 2019 were also evaluated. RESULTS There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05 (95% UI, 12.31-20.77) per 100,000 in 2019. The estimated number of incident case and deaths of MM were 18,793 and 13,421, with age-standardized incidence and mortality rates of 0.93 (95% UI, 0.67-1.15) and 0.67 (95% UI, 0.50-0.82) per 100,000, respectively. The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak (93.82) in the 70 to 74 years age group. Males had a higher burden than females, with approximately 1.5- to 2.0-fold sex difference in age-specific DALY rates in all age groups. From 1990 to 2019, the DALYs of MM increased 134%, from 148,479 in 1990 to 347,453 in 2019. CONCLUSION The burden of MM has doubled over the last three decades, which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.
Collapse
Affiliation(s)
- Jiangmei Liu
- Department of Vital Statistics and Death Surveillance National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Weiping Liu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Lan Mi
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Cai Cai
- Strategic Development Department, Beijing Institute of Survey and Mapping, Beijing Municipal Key Laboratory of Urban Spatial Information Engineering, Beijing 100038, China
| | - Tiejun Gong
- Department of Hematology & Oncology, Harbin Institute of Hematology and Oncology, Harbin, Heilongjiang 150010, China
| | - Jun Ma
- Department of Hematology & Oncology, Harbin Institute of Hematology and Oncology, Harbin, Heilongjiang 150010, China
| | - Lijun Wang
- Department of Vital Statistics and Death Surveillance National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| |
Collapse
|
3
|
Dally N, Baranes M, Akria L, Kashlikov M, Tarabia K, Sharabi-Nov A, Suriu C, Braester A. Ethnic disparities in presentation but not outcome in multiple myeloma patients: a multicenter retrospective study in Northern Israel. Leuk Lymphoma 2023; 64:2148-2155. [PMID: 37715316 DOI: 10.1080/10428194.2023.2251072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/17/2023]
Abstract
Several studies showed ethnic disparities in multiple myeloma (MM) incidence and prognosis. In order to compare prognosis and overall survival between different ethnic groups, a multicenter retrospective study was conducted in Northern Israel. A total of 145 patients suffering from MM were included (72% Jewish, and 28% Arabs) who were treated between 2008-2018. A difference was found in the stage of the disease at the time of diagnosis, patients of Arab origin were diagnosed at a more advanced stage (III), (53.7% vs. 33.7%, respectively). A mortality rate of 48.9% was found in the study, regardless of population ethnic origin. No significant differences in rates of MGUS, MM symptoms, treatments, or progression-free survival (PFS) and overall survival (OS) were observed between ethnic groups. This suggests that raising awareness of MM may result in an earlier diagnosis, especially among patients of Arab origin, preventing unnecessary suffering from these patients.
Collapse
Affiliation(s)
- Najib Dally
- Hematology Institute Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Myriam Baranes
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
| | | | | | - Adi Sharabi-Nov
- Hematology Institute Ziv Medical Center, Safed, Israel
- Tel-Hai Academic College, Kiryat Shmona, Israel
| | - Celia Suriu
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Hematology Institute the Galilee Medical Center, Naharia, Israel
| |
Collapse
|
4
|
Mateos MV, Ailawadhi S, Costa LJ, Grant SJ, Kumar L, Mohty M, Aydin D, Usmani SZ. Global disparities in patients with multiple myeloma: a rapid evidence assessment. Blood Cancer J 2023; 13:109. [PMID: 37460466 PMCID: PMC10352266 DOI: 10.1038/s41408-023-00877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
There are disparities in outcomes for patients with multiple myeloma (MM). We evaluated the influence of sociodemographic factors on global disparities in outcomes for patients with MM. This rapid evidence assessment (PROSPERO, CRD42021248461) followed PRISMA-P guidelines and used the PICOS framework. PubMed and Embase® were searched for articles in English from 2011 to 2021. The title, abstract, and full text of articles were screened according to inclusion/exclusion criteria. The sociodemographic factors assessed were age, sex, race/ethnicity, socioeconomic status, and geographic location. Outcomes were diagnosis, access to treatment, and patient outcomes. Of 84 articles included, 48 were US-based. Worldwide, increasing age and low socioeconomic status were associated with worse patient outcomes. In the US, men typically had worse outcomes than women, although women had poorer access to treatment, as did Black, Asian, and Hispanic patients. No consistent disparities due to sex were seen outside the US, and for most factors and outcomes, no consistent disparities could be identified globally. Too few studies examined disparities in diagnosis to draw firm conclusions. This first systematic analysis of health disparities in patients with MM identified specific populations affected, highlighting a need for additional research focused on assessing patterns, trends, and underlying drivers of disparities in MM.
Collapse
Affiliation(s)
| | - Sikander Ailawadhi
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Jackson, FL, USA
| | - Luciano J Costa
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamad Mohty
- Sorbonne University, Department of Hematology, Saint-Antoine Hospital, Paris, France
| | | | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
5
|
Gandhi M, Bakhai V, Trivedi J, Mishra A, De Andrés F, LLerena A, Sharma R, Nair S. Current perspectives on interethnic variability in multiple myeloma: Single cell technology, population pharmacogenetics and molecular signal transduction. Transl Oncol 2022; 25:101532. [PMID: 36103755 PMCID: PMC9478452 DOI: 10.1016/j.tranon.2022.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/15/2022] Open
Abstract
This review discusses the emerging single cell technologies and applications in Multiple myeloma (MM), population pharmacogenetics of MM, resistance to chemotherapy, genetic determinants of drug-induced toxicity, molecular signal transduction. The role(s) of epigenetics and noncoding RNAs including microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) that influence the risk and severity of MM are also discussed. It is understood that ethnic component acts as a driver of variable response to chemotherapy in different sub-populations globally. This review augments our understanding of genetic variability in ‘myelomagenesis’ and drug-induced toxicity, myeloma microenvironment at the molecular and cellular level, and developing precision medicine strategies to combat this malignancy. The emerging single cell technologies hold great promise for enhancing our understanding of MM tumor heterogeneity and clonal diversity.
Multiple myeloma (MM) is an aggressive cancer characterised by malignancy of the plasma cells and a rising global incidence. The gold standard for optimum response is aggressive chemotherapy followed by autologous stem cell transplantation (ASCT). However, majority of the patients are above 60 years and this presents the clinician with complications such as ineligibility for ASCT, frailty, drug-induced toxicity and differential/partial response to treatment. The latter is partly driven by heterogenous genotypes of the disease in different subpopulations. In this review, we discuss emerging single cell technologies and applications in MM, population pharmacogenetics of MM, resistance to chemotherapy, genetic determinants of drug-induced toxicity, molecular signal transduction, as well as the role(s) played by epigenetics and noncoding RNAs including microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) that influence the risk and severity of the disease. Taken together, our discussions further our understanding of genetic variability in ‘myelomagenesis’ and drug-induced toxicity, augment our understanding of the myeloma microenvironment at the molecular and cellular level and provide a basis for developing precision medicine strategies to combat this malignancy.
Collapse
Affiliation(s)
- Manav Gandhi
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd., Orlando, FL 32827, USA
| | - Viral Bakhai
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS University, V. L. Mehta Road, Vile Parle (West), Mumbai 400056, India
| | - Jash Trivedi
- University of Mumbai, Santa Cruz, Mumbai 400055, India
| | - Adarsh Mishra
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS University, V. L. Mehta Road, Vile Parle (West), Mumbai 400056, India
| | - Fernando De Andrés
- INUBE Extremadura Biosanitary Research Institute, Badajoz, Spain; Faculty of Medicine, University of Extremadura, Badajoz, Spain; CICAB Clinical Research Center, Pharmacogenetics and Personalized Medicine Unit, Badajoz University Hospital, Extremadura Health Service, Badajoz, Spain
| | - Adrián LLerena
- INUBE Extremadura Biosanitary Research Institute, Badajoz, Spain; Faculty of Medicine, University of Extremadura, Badajoz, Spain; CICAB Clinical Research Center, Pharmacogenetics and Personalized Medicine Unit, Badajoz University Hospital, Extremadura Health Service, Badajoz, Spain
| | - Rohit Sharma
- Department of Rasa Shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
| | - Sujit Nair
- University of Mumbai, Santa Cruz, Mumbai 400055, India.
| |
Collapse
|
6
|
Xu J, Xu P, Han Q, Sun J, Chen B, Dong X. Socioeconomic status-based survival disparities and nomogram prediction for patients with multiple myeloma: Results from American and Chinese populations. Front Oncol 2022; 12:941714. [PMID: 36091116 PMCID: PMC9458969 DOI: 10.3389/fonc.2022.941714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to comprehensively investigate the relationship between the survival differences and socioeconomic status (SES) in patients with multiple myeloma (MM) and construct a predictive nomogram to assess clinical outcomes of MM patients. Methods The Surveillance, Epidemiology, and End Results (SEER) census tract-level SES database provides two specialized attributes: SES index and rurality. Using this database, 37,819 patients diagnosed with MM between January 2007 and December 2016 were enrolled. We evaluated the effects of SES index on overall survival (OS) and myeloma-specific survival (MSS) using Kaplan-Meier curves and Cox regression analyses. Thereafter, we included 126 patients with MM from two independent medical centers in China and divided them into training (Center 1) and validation (Center 2) cohorts. Univariate and multivariate Cox analyses were used in the training cohort to construct a nomogram for predicting clinical outcomes. Nomogram performance was assessed using the area under the curve (AUC) and calibration curves. Results In the SEER cohort, lower SES was significantly associated with worse OS rates and MSS rates (both P < 0.001). Multivariate analysis confirmed SES as an independent predictor of survival. Subgroup analysis indicated an increasing linear trend in survival benefits in non-Hispanic White, married, insured, and urban populations with increasing SES (all P < 0.001). In the training cohort, albumin, creatinine, rurality, and SES were confirmed as independent prognostic indicators. A nomogram for OS prediction was developed using these four factors, and it showed satisfactory discrimination and calibration. The 18- and 36-month AUC values of the nomogram were 0.79 and 0.82, respectively. Based on the total nomogram points, patients were categorized into two risk levels with good separation. Conclusion SES strongly influences survival disparities in patients with MM. Our nomogram consisting of clinical and sociodemographic characteristics can potentially predict survival outcomes.
Collapse
Affiliation(s)
- Jiaxuan Xu
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Peipei Xu
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiaoyan Han
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Department of Hematology, Jingjiang People’s Hospital, Jingjiang, China
| | - Jingjing Sun
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Chen
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoqing Dong
- Department of Hematology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Xiaoqing Dong,
| |
Collapse
|
7
|
Socioeconomic Status is Globally a Prognostic Factor for Overall Survival of Multiple Myeloma Patients: Synthesis of Studies and Review of the Literature. Mediterr J Hematol Infect Dis 2021; 13:e2021006. [PMID: 33489045 PMCID: PMC7813274 DOI: 10.4084/mjhid.2021.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
Background Socioeconomic status (SES) is reflecting differences in sociodemographic factors affecting cancer survivorship. Deprived, low SES populations have a higher prevalence of multiple myeloma and worst survival, a condition which widens over time. Methods We performed a meta-analysis of 16 studies (registries and cohorts) reporting myeloma patients’ survival data according to SES. Ten studies reported Hazzard Ratio (H.R.) (95 % CI), and 16 studies reported p values. We combined the H.R. from 10 studies, and by using the Mosteller-Bush formula, we performed a synthesis of p values according to the area of the globe. Results Combination of H.R. from 10 studies including 85198 myeloma patients weighted to sample size of each study and adopting the hypothesis of random effect returned a combined H.R.: 1,26 (1,13–1,31) in favor of high SES patients. USA: Synthesis of p values coming from 6 studies (n=89807 pts) by using the Mosteller and Bush formula extracted a p-value of <0.0001 favoring high SES patients. Oceania: Synthesis of p values in two cohorts from Australia and New Zealand (n= 10196 pts) returned a p-value of 0,022 favoring high SES patients. Europe: The synthesis of p values from the U.K. and Greece studies (n=18533 pts) returned a p-value of <0,0001 favoring high SES patients. Asia: Synthesis of 2 studies from Asia (n=915 pts) returned a p-value of <0,0001 favoring high SES patients. Conclusions Across the globe and widening over decades, the socioeconomic status remains a gap for equality in myeloma care.
Collapse
|
8
|
Jayakrishnan TT, Bakalov V, Chahine Z, Lister J, Wegner RE, Sadashiv S. Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma. Hematol Oncol Stem Cell Ther 2020; 14:218-230. [PMID: 33069693 PMCID: PMC7546959 DOI: 10.1016/j.hemonc.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Disparities driven by socioeconomic factors have been shown to impact outcomes for cancer patients. We sought to explore this relationship among patients with multiple myeloma (MM) who were not considered for hematopoietic stem cell transplant in the first-line setting and how it varied over time. Methods We queried the National Cancer Database for patients diagnosed with MM between 2004 and 2016 and included only those who received systemic therapy as the first-line treatment. Enrollment rates for therapy were calculated as receipt of systemic therapy as the incident event of interest (numerator) over time to initiation of therapy (denominator) and used to calculate incident rate ratios that were further analyzed using Poisson regression analysis. A multivariate Cox proportional hazards model was constructed for survival analysis, and differences were reported as hazard ratios (HRs). Results We identified 56,102 patients for enrollment analysis and 50,543 patients for survival analysis. Therapy enrollment in a multivariate model was significantly impacted by race and sex (p < .005). Advanced age, earlier year of diagnosis, lack of insurance or Medicaid, and higher comorbidity were associated with poor survival (HR > 1), whereas female sex, non-Hispanic black race, higher income, and treatment at an academic center were associated with improved survival (HR < 1). Conclusion Disparities in treatment of MM exist and are caused by a complex interplay of multiple factors, with socioeconomic factor playing a significant role. Studies exploring such determinants may help in equitable distribution of resources to overcome such differences.
Collapse
Affiliation(s)
| | - Veli Bakalov
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Zena Chahine
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Santhosh Sadashiv
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Ailawadhi S, Jagannath S, Lee HC, Narang M, Rifkin RM, Terebelo HR, Durie BGM, Toomey K, Hardin JW, Gasparetto CJ, Wagner L, Omel JL, He M, Yue L, Flick ED, Agarwal A, Abonour R. Association between race and treatment patterns and survival outcomes in multiple myeloma: A Connect MM Registry analysis. Cancer 2020; 126:4332-4340. [PMID: 32706404 PMCID: PMC7540439 DOI: 10.1002/cncr.33089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
Background Studies have reported racial disparities in access to and use of multiple myeloma (MM) treatments between African American (AA) and White patients. Although AA patients demonstrate longer disease‐specific survival, this has not uniformly translated into improved survival over time. The association between race and treatment patterns and survival outcomes was analyzed using data from the Connect MM Registry. Methods The Connect MM Registry is a large US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Patients who received first‐line (1L) stem cell transplantation (SCT) or who did not receive SCT (non‐SCT or non–stem cell transplantation [NSCT]) were grouped by raceEffects of race and transplantation status on the use of triplet treatment were estimated using logistic regression. Results Treatment patterns in 1L (types and duration of induction, posttransplantation maintenance) were similar between AA and White patients. SCT rates in 1L (32% vs 36%) and triplet treatment use (AA: 44% for NSCT patients and 72% for SCT patients; and White: 48% for NSCT patients and 72% for SCT patients) during first induction were similar. No significant effect of race or transplantation status on 1L triplet treatment use was observed. Race was not found to be associated with survival outcomes among patients who underwent NSCT; however, AA patients who received SCT had significantly longer overall survival compared with White patients who underwent SCT (not reached vs 88.2 months; hazard ratio, 0.56; 95% CI, 0.35‐0.89 [P = .0141]). Conclusions AA and White patients were found to have similar treatment patterns in the Connect MM Registry, suggesting that both groups had equal access to health care. In this real‐world setting, AA patients received standard‐of‐care treatment, which might have contributed to better MM‐specific survival compared with White patients. Real‐world data from the mostly community‐based Connect MM Registry demonstrated that African American patients have multiple myeloma treatment patterns that are similar to those of White patients. Similar (progression‐free survival) and better (overall survival) survival outcomes are reported in African American individuals.
Collapse
Affiliation(s)
| | | | - Hans C Lee
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Robert M Rifkin
- Rocky Mountain Cancer Centers, US Oncology Research, Denver, Colorado
| | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James L Omel
- Myeloma Research Advocate/Advisor, Grand Island, Nebraska
| | - Mia He
- Bristol-Myers Squibb, Summit, New Jersey
| | - Lihua Yue
- Bristol-Myers Squibb, Summit, New Jersey
| | | | | | | | | |
Collapse
|
10
|
Xu L, Wang X, Pan X, Wang X, Wang Q, Wu B, Cai J, Zhao Y, Chen L, Li W, Li J. Education level as a predictor of survival in patients with multiple myeloma. BMC Cancer 2020; 20:737. [PMID: 32770980 PMCID: PMC7414648 DOI: 10.1186/s12885-020-07178-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes. METHODS We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed. RESULTS Overall, 69.2% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had a median progression-free survival (PFS) of 67.50 (95% confidence interval (CI): 51.66-83.39) months, which was better than that of patients with low education levels (30.60 months, 95% CI: 27.38-33.82, p < 0.001). Similarly, patients with high education levels had a median overall survival (OS) of 122.27 (95% CI: 117.05-127.49) months, which was also better than that of patients with low education levels (58.83 months, 95% CI: 48.87-62.79, p < 0.001). In the multivariable analysis, patients with high education levels had lower relapse rates and higher survival rates than did those with low education level in terms of PFS and OS (hazard ratio (HR) = 0.50 [95% CI: 0.34-0.72], p < 0.001; HR = 0.32 [0.19-0.56], p < 0.001, respectively). CONCLUSIONS Low education levels may independently predict poor survival in MM patients in China.
Collapse
Affiliation(s)
- Limei Xu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiuju Wang
- Department of Hematology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xueyi Pan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xiaotao Wang
- Department of Hematology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Qing Wang
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Bingyi Wu
- Department of Hematology, Shunde Hospital of Southern Medical University, Shunde, Guangdong, China
| | - Jiahui Cai
- Department of Hematology, Shunde Hospital of Southern Medical University, Shunde, Guangdong, China
| | - Ying Zhao
- Department of Hematology, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Lijuan Chen
- Department of Hematology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wuping Li
- Department of Internal Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
11
|
Jansen L, Merz M, Engelhardt M, Weisel K, Scheid C, Straka C, Langer C, Salwender H, Einsele H, Kröger N, Beelen DW, Dreger P, Goldschmidt H, Brenner H. Autologous stem cell transplantation in multiple myeloma patients: utilization patterns and hospital effects. Leuk Lymphoma 2020; 61:2365-2374. [PMID: 32476543 DOI: 10.1080/10428194.2020.1768383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Evidence on volume outcome associations for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) is limited. We investigated ASCT utilization patterns and volume outcome associations in the German National Registry for Stem Cell Transplants (DRST). MM patients with an upfront ASCT between 1998 and 2014 registered in the DRST were included. ASCT utilization increased strongly from 6% to 17% between 1999 and 2013 with the largest increase for patients aged 60-64 years (8-34%). The mean number of ASCTs conducted in the hospitals per year varied (quintiles, Q1:0.0-8.2 to Q5:31.0-102.7). Center volume was not associated with survival after upfront ASCT (lowest vs. highest center volume, hazard ratios and 95% confidence intervals: 0.95 (0.76-1.18), p = 0.92). Our findings may reflect a high standard of care and degree of specialization of centers performing ASCT for MM in Germany.
Collapse
Affiliation(s)
- Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maximilian Merz
- Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Katja Weisel
- II. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Hans Salwender
- Asklepios Kliniken Altona und St. Georg, Hamburg, Germany
| | | | - Nikolaus Kröger
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dietrich W Beelen
- Klinik für Knochenmarktransplantation des Universitätsklinikums Essen, Essen, Germany
| | - Peter Dreger
- Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Hermann Brenner
- Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | | |
Collapse
|
12
|
Yu Y, Brown Wade N, Hwang AE, Nooka AK, Fiala MA, Mohrbacher A, Peters ES, Pawlish K, Bock C, Van Den Berg DJ, Rand KA, Stram D, Conti DV, Auclair D, Colditz GA, Mehta J, Haiman CA, Terebelo H, Janakiraman N, Singhal S, Chiu B, Vij R, Bernal-Mizrachi L, Zonder JA, Huff CA, Lonial S, Orlowski RZ, Cozen W, Ailawadhi S. Variability in Cytogenetic Testing for Multiple Myeloma: A Comprehensive Analysis From Across the United States. JCO Oncol Pract 2020; 16:e1169-e1180. [PMID: 32469686 DOI: 10.1200/jop.19.00639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Multiple myeloma (MM) treatment has changed tremendously, with significant improvement in patient out-comes. One group with a suboptimal benefit is patients with high-risk cytogenetics, as tested by conventional karyotyping or fluorescence in situ hybridization (FISH). Methodology for these tests has been published, but not necessarily standardized. METHODS We address variability in the testing and reporting methodology for MM cytogenetics in the United States using the ongoing African American Multiple Myeloma Study (AAMMS). We evaluated clinical and cytogenetic data from 1,221 patients (1,161 with conventional karyotyping and 976 with FISH) tested between 1998 and 2016 across 58 laboratories nationwide. RESULTS Interlab and intralab variability was noted for the number of cells analyzed for karyotyping, with a significantly higher number of cells analyzed in patients in whom cytogenetics were normal (P 5.0025). For FISH testing, CD138-positive cell enrichment was used in 29.7% of patients and no enrichment in 50% of patients, whereas the remainder had unknown status. A significantly smaller number of cells was analyzed for patients in which CD138 cell enrichment was used compared with those without such enrichment (median, 50 v 200; P, .0001). A median of 7 loci probes (range, 1-16) were used for FISH testing across all laboratories, with variability in the loci probed even within a given laboratory. Chromosome 13-related abnormalities were the most frequently tested abnormality (n5956; 97.9%), and t(14;16) was the least frequently tested abnormality (n 5 119; 12.2%). CONCLUSIONS We report significant variability in cytogenetic testing across the United States for MM, potentially leading to variability in risk stratification, with possible clinical implications and personalized treatment approaches.
Collapse
Affiliation(s)
- Yang Yu
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Niquelle Brown Wade
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Amie E Hwang
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Ajay K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mark A Fiala
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Ann Mohrbacher
- Department of Medicine, Division of Hematology, University of Southern California, Los Angeles, CA
| | - Edward S Peters
- Louisiana State University School of Public Health, New Orleans, LA
| | | | - Cathryn Bock
- Karmanos Cancer Center, Wayne State University, Detroit, MI
| | - David J Van Den Berg
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | | | | | - David V Conti
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | | | - Graham A Colditz
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jayesh Mehta
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christopher A Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | | | | | - Seema Singhal
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian Chiu
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Ravi Vij
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | | | | | - Carol A Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy Cozen
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA.,Department of Pathology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | | |
Collapse
|
13
|
Kumar V, Alhaj-Moustafa M, Bojanini L, Sher T, Roy V, Manochakian R, Vishnu P, Bodepudi S, Shareef Z, Ahmed S, Jani P, Paulus A, Grover A, Alegria VR, Ailawadhi M, Chanan-Khan A, Ailawadhi S. Timeliness of Initial Therapy in Multiple Myeloma: Trends and Factors Affecting Patient Care. JCO Oncol Pract 2020; 16:e341-e349. [DOI: 10.1200/jop.19.00309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) treatment has advanced significantly over the last 2 decades. In most patients, the disease course has been altered from early fatality to chronic morbidity with multiple lines of treatment. The MM treatment paradigm has shifted toward treating patients before end-organ damage occurs. Thus, timeliness of treatment initiation in this era might improve patient outcomes. This is the first report to our knowledge analyzing disparities and trends in treatment timeliness of patients with MM using the National Cancer Database. Multiple factors affected the timing of treatment initiation in MM and disparities were found. We noted that initiation of treatment was delayed in women (odds ratio [OR], 1.15; 95% CI, 1.1 to 1.2) and blacks (OR, 1.21; 95% CI, 1.14 to 1.28; reference, whites) and in patients diagnosed in more recent years (2012-2015; OR, 1.15; 95% CI, 1.1 to 1.22; reference, 2004-2007). Patients were likely to start treatment earlier if they were age ≥ 80 years (OR, 0.83; 95% CI, 0.76 to 0.9; reference, age < 60 years), were uninsured (OR, 0.81; 95% CI, 0.72 to 0.91; reference, private insurance), had Medicaid (OR, 0.87; 95% CI, 0.79 to 0.95; reference, private insurance), were treated in a comprehensive community cancer program (OR, 0.7; 95% CI, 0.65 to 0.77; reference, community cancer program), lived in a location other than the US Northeast, or had a higher Charlson comorbidity score. Patient education and income levels did not affect 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.
Collapse
Affiliation(s)
| | | | - Leyla Bojanini
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Rami Manochakian
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Prakash Vishnu
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Zan Shareef
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Salman Ahmed
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Prachi Jani
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Aneel Paulus
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL
| | - Ashna Grover
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Meghna Ailawadhi
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | | | | |
Collapse
|
14
|
Marinac CR, Ghobrial IM, Birmann BM, Soiffer J, Rebbeck TR. Dissecting racial disparities in multiple myeloma. Blood Cancer J 2020; 10:19. [PMID: 32066732 PMCID: PMC7026439 DOI: 10.1038/s41408-020-0284-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Multiple myeloma (MM) is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. MM progresses from the more common but often subclinical precursor states of monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) to overt MM. There are large racial disparities in all stages of the disease. Compared with Whites, Blacks have an increased MGUS and MM risk and higher mortality rate, and have not experienced the same survival gains over time. The roots of this disparity are likely multifactorial in nature. Comparisons of Black and White MGUS and MM patients suggest that differences in risk factors, biology, and clinical characteristics exist by race or ancestry, which may explain some of the observed disparity in MM. However, poor accrual of Black MGUS and MM patients in clinical and epidemiological studies has limited our understanding of this disparity and hindered its elimination. Disparities in MM survival also exist but appear to stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of disparities that exist at each stage of the MM disease continuum and facilitate their elimination.
Collapse
Affiliation(s)
- Catherine R Marinac
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jenny Soiffer
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| |
Collapse
|
15
|
Ailawadhi S, Azzouqa AG, Hodge D, Cochuyt J, Jani P, Ahmed S, Sher T, Roy V, Ailawadhi M, Alegria VR, Manochakian R, Vishnu P, Grover A, Abdulazeez MF, Paulus A, Chanan-Khan A. Survival Trends in Young Patients With Multiple Myeloma: A Focus on Racial-Ethnic Minorities. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:619-623. [PMID: 31377212 DOI: 10.1016/j.clml.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Outcomes in multiple myeloma (MM) have improved significantly over time. This is true overall for all patients as well as patient subgroups based on age and race/ethnicity. Despite this, disparities are noted in outcomes when looking at racial subgroups. MATERIALS AND METHODS We performed an analysis from the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate improvement in relative survival rates (RSRs) for young (≤ 40 years at the time of MM diagnosis) and older (> 40 years at the time of MM diagnosis) over time by race/ethnicity, specifically focusing on Hispanic patients with MM. Expected survival was estimated using the age- and gender-specific death rates from the United States population. RSR was provided as the ratio of the observed to expected survival at individual time points. Five-year and 10-year RSRs were calculated for patients based on treatments modalities available in various time periods. RESULTS We identified a total of 89,451 patients with MM in SEER, of which 1460 patients formed the young patients with MM (≤ 40 years) cohort. Five- and 10-year RSR improved significantly over time for all patients and older patients (> 40 years) by race (all P < .001). Evaluating the younger patients, RSR improved significantly for non-Hispanic whites and non-Hispanic blacks, but not for Hispanics. This was true for the 5-year (P = .08) and 10-year (P = .13) RSRs. CONCLUSION We report a lack of significant benefit in long-term outcomes for younger Hispanic patients with MM over time. This could be owing to multifactorial causes that need to be addressed to mitigate outcome disparities.
Collapse
Affiliation(s)
| | | | - David Hodge
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL
| | - Jordan Cochuyt
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL
| | - Prachi Jani
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Salman Ahmed
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | - Prakash Vishnu
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Ashna Grover
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Aneel Paulus
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | | |
Collapse
|
16
|
Ganguly S, Mailankody S, Ailawadhi S. Many Shades of Disparities in Myeloma Care. Am Soc Clin Oncol Educ Book 2019; 39:519-529. [PMID: 31099639 DOI: 10.1200/edbk_238551] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Treatment of multiple myeloma (MM) has notably evolved with improved patient outcomes over the past few years. Several new drugs have become available, and large national and international clinical trials have set the stage for evidence-based medicine guidelines for the treatment of patients with MM. Although patient outcomes have undoubtedly improved, data increasingly show that several disparities exist at varying levels of health care and that these disparities make the care of patients heterogenous and potentially result in inferior outcomes. These disparities have been described with regard to patient age, race/ethnicity, rural-urban residence, socioeconomic status, and insurance type, among other factors. Looking at the global picture of MM care, there is substantial variation among different countries, primarily depending on the disparate availability of anti-MM drugs and access to quality health care across the world, limiting the delivery of innovative therapeutic approaches at the individual patient level. The causes of these national and international disparities could be multifactorial, intricate, and difficult to isolate. Yet the ongoing research in this field is encouraging, and there seems to be growing momentum to understand such disparities and their causes. It is hoped that this research will lead to solutions that can be implemented in the near future. This review focuses on certain aspects of disparities in MM care, highlighting disparities among different racial/ethnic subgroups, rural-urban differences in America, and global disparities at an international level.
Collapse
Affiliation(s)
- Siddhartha Ganguly
- 1 Department of Hematologic Malignancy and Cellular Therapeutics, University of Kansas Health System, Westwood, KS
| | - Sham Mailankody
- 2 Myeloma Service, Cellular Therapeutics Center, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
| | | |
Collapse
|
17
|
Hekkert K, Kool RB, Rake E, Cihangir S, Borghans I, Atsma F, Westert G. To what degree can variations in readmission rates be explained on the level of the hospital? a multilevel study using a large Dutch database. BMC Health Serv Res 2018; 18:999. [PMID: 30591058 PMCID: PMC6307249 DOI: 10.1186/s12913-018-3761-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It is not clear which part of the variation in hospital readmissions can be attributed to the standard of care hospitals provide. This is in spite of their widespread use as an indicator of a lower quality of care. The aim of this study is to assess the variation in readmissions on the hospital level after adjusting for case-mix factors. METHODS We performed multilevel logistic regression analyses with a random intercept for the factor 'hospital' to estimate the variance on the hospital level after adjustment for case-mix variables. We used administrative data from 53 Dutch hospitals from 2010 to 2012 (58% of all Dutch hospitals; 2,577,053 admissions). We calculated models for the top ten diagnosis groups with the highest number of readmissions after an index admission for a surgical procedure. We calculated intraclass correlation coefficients (ICC) per diagnosis group in order to explore the variation in readmissions between hospitals. Furthermore, we determined C-statistics for the models with and without a random effect on the hospital level to determine the discriminative ability. RESULTS The ICCs on the hospital level ranged from 0.48 to 2.70% per diagnosis group. The C-statistics of the models with a random effect on the hospital level ranged from 0.58 to 0.65 for the different diagnosis groups. The C-statistics of the models that included the hospital level were higher compared to the models without this level. CONCLUSIONS For some diagnosis groups, a small part of the explained variation in readmissions was found on the hospital level, after adjusting for case-mix variables. However, the C-statistics of the prediction models are moderate, so the discriminative ability is limited. Readmission indicators might be useful for identifying areas for improving quality within hospitals on the level of diagnosis or specialty.
Collapse
Affiliation(s)
- Karin Hekkert
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Dutch Health and Youth Care Inspectorate (IGJ), Utrecht, The Netherlands
| | - Rudolf B. Kool
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Ester Rake
- Dutch Hospital Data, Utrecht, The Netherlands
| | | | - Ine Borghans
- Dutch Health and Youth Care Inspectorate (IGJ), Utrecht, The Netherlands
| | - Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Gert Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| |
Collapse
|
18
|
Ailawadhi S, Jacobus S, Sexton R, Stewart AK, Dispenzieri A, Hussein MA, Zonder JA, Crowley J, Hoering A, Barlogie B, Orlowski RZ, Rajkumar SV. Disease and outcome disparities in multiple myeloma: exploring the role of race/ethnicity in the Cooperative Group clinical trials. Blood Cancer J 2018; 8:67. [PMID: 29980678 PMCID: PMC6035273 DOI: 10.1038/s41408-018-0102-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM) is an incurable hematologic malignancy with disparities in outcomes noted among racial-ethnic subgroups, likely due to disparities in access to effective treatment modalities. Clinical trials can provide access to evidence-based medicine but representation of minorities on therapeutic clinical trials has been dismal. We evaluated the impact of patient race-ethnicity in pooled data from nine large national cooperative group clinical trials in newly diagnosed MM. Among 2896 patients enrolled over more than two decades, only 18% were non-White and enrollment of minorities actually decreased in most recent years (2002-2011). African-Americans were younger and had more frequent poor-risk markers, including anemia and increased lactate dehydrogenase. Hispanics had the smallest proportion of patients on trials utilizing novel therapeutic agents. While adverse demographic (increased age) and clinical (performance status, stage, anemia, kidney dysfunction) factors were associated with inferior survival, patient race-ethnicity did not have an effect on objective response rates, progression-free, or overall survival. While there are significant disparities in MM incidence and outcomes among patients of different racial-ethnic groups, this disparity seems to be mitigated by access to appropriate therapeutic options, for example, as offered by clinical trials. Improved minority accrual in therapeutic clinical trials needs to be a priority.
Collapse
Affiliation(s)
| | - Susanna Jacobus
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Rachael Sexton
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | | | | | | | - Jeffrey A Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - John Crowley
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | - Antje Hoering
- South West Oncology Group (SWOG) Statistical Center, Seattle, WA, USA
| | | | - Robert Z Orlowski
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | | |
Collapse
|
19
|
Ailawadhi S, Frank RD, Sharma M, Menghani R, Temkit M, Paulus S, Khera N, Hashmi S, Advani P, Swaika A, Paulus A, Aslam N, Sher T, Roy V, Colon-Otero G, Chanan-Khan A. Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities. Cancer 2018; 124:1710-1721. [DOI: 10.1002/cncr.31237] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/09/2017] [Accepted: 12/18/2017] [Indexed: 12/25/2022]
Affiliation(s)
| | - Ryan D. Frank
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Mayank Sharma
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Richa Menghani
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - M'hamed Temkit
- Department of Health Sciences Research; Mayo Clinic; Scottsdale Arizona
| | - Shumail Paulus
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Nandita Khera
- Division of Hematology-Oncology; Mayo Clinic; Phoenix Arizona
| | - Shahrukh Hashmi
- Division of Hematology-Oncology; Mayo Clinic; Rochester Minnesota
| | - Pooja Advani
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Abhisek Swaika
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Aneel Paulus
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Nabeel Aslam
- Division of Nephrology and Hypertension; Mayo Clinic; Jacksonville Florida
| | - Taimur Sher
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | - Vivek Roy
- Division of Hematology-Oncology; Mayo Clinic; Jacksonville Florida
| | | | | |
Collapse
|