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Fiala MA, Ji M, Shih YH, Huber J, Wang M, Johnson KJ, Gasoyan H, Wang R, Colditz GA, Wang SY, Chang SH. Treatment Access among Younger Medicaid Beneficiaries with Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00286-6. [PMID: 39209567 DOI: 10.1016/j.clml.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events. MATERIALS AND METHODS This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date. RESULTS Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1st year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; P < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; P = .005). CONCLUSION Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care.
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Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis MO.
| | - Mengmeng Ji
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Yi-Hsuan Shih
- Department of Electrical & Systems Engineering, Washington University School of Medicine, St Louis MO
| | - John Huber
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Mei Wang
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Kimberly J Johnson
- Brown School of Social Work, Washington University School of Medicine, St Louis MO
| | - Hamlet Gasoyan
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland OH
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven CT
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven CT
| | - Su-Hsin Chang
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis MO
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Gasoyan H, Anwer F, Casacchia NJ, Kovach JD, Valent J, Wang M, Halpern MT, Rothberg MB. Role of Patient Characteristics and Insurance Type in Newly Diagnosed Multiple Myeloma Care Disparities. JCO Oncol Pract 2024; 20:699-707. [PMID: 38354331 DOI: 10.1200/op.23.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM). METHODS This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022. Multivariable logistic regression models examined associations of demographic/clinical characteristics and SDOH with care patterns. RESULTS We identified 569 patients with median age at diagnosis of 66 years (IQR, 59-73); 55% were male, 76% White, 23% Black, 1.1% other races, insured by Medicare (51%), private payer (38%), Medicaid (8.3%), and self-pay/other (1.8%). In the multivariable models, self-pay/other payers (adjusted odds ratio [AOR], 0.15 [95% CI, 0.03 to 0.54]) was associated with lower odds of triplet or quadruplet regimen, compared with Medicare. Private insurance (AOR, 0.48 [95% CI, 0.27 to 0.86]) and self-pay/other payers (AOR, 0.16 [95% CI, 0.04 to 0.74]) had lower odds of lenalidomide. Black patients (v White; AOR, 0.47 [95% CI, 0.26 to 0.85]) and patients treated at regional hospitals (v Taussig Cancer Center; AOR, 0.27 [95% CI, 0.12 to 0.57]) had lower odds of SCT. The odds of receiving triplet or quadruplet regimen, lenalidomide, and SCT also varied by the year of NDMM. CONCLUSION Care for NDMM varied based on race, insurance type, year of diagnosis, and treatment facility. It may be useful to examine the impact of insurance-related characteristics and recent policy initiatives on care disparities.
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Affiliation(s)
- Hamlet Gasoyan
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Faiz Anwer
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Nicholas J Casacchia
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
| | - Jeffrey D Kovach
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Jason Valent
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Michael B Rothberg
- Department of Internal Medicine and Geriatrics, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Saunders A, Slaff S, Subbiah K, Gu T, Ang KK, Quan MA, Rosenberg AS. Clinical characteristics, treatment patterns, and outcomes among African American and White patients with multiple myeloma in the United States. Leuk Lymphoma 2024; 65:109-117. [PMID: 37917858 DOI: 10.1080/10428194.2023.2273746] [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: 06/19/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023]
Abstract
Multiple myeloma (MM) is more common among Black/African American (AA) patients than White patients, but survival rate improvements are less pronounced for AA patients. This study evaluated treatment patterns and survival among 1810 AA and 5904 White adults in the United States with ≥1 MM treatment and ≥3 months of follow-up. Median time from diagnosis to systemic treatment was longer (37 [0-3053] vs. 35 [0-3664] days) and median time to stem cell transplant (SCT) was longer for AA than White patients (255 [1-2352] vs. 225 [1-3094] days), and AA patients were less likely to receive SCT (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.58-0.76). Despite disparities in treatment between AA and White patients, AA patients demonstrated lower risk of death (OR: 0.89; 95% CI: 0.81-0.96). These data highlight the value of equal access to care for the improvement of health outcomes in underserved populations.
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Affiliation(s)
| | | | | | - Tao Gu
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Kwan-Keat Ang
- University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Aaron Seth Rosenberg
- Comprehensive Cancer Center, Division of Malignant Hematology, Cellular Therapy & Transplantation, University of California Davis Medical Center, Sacramento, CA, USA
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Bhutani M, Blue BJ, Cole C, Badros AZ, Usmani SZ, Nooka AK, Bernal-Mizrachi L, Mikhael J. Addressing the disparities: the approach to the African American patient with multiple myeloma. Blood Cancer J 2023; 13:189. [PMID: 38110338 PMCID: PMC10728116 DOI: 10.1038/s41408-023-00961-0] [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: 09/10/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
There are significant disparities with regards to incidence, timely diagnosis, access to treatment, clinical trial participation and health care utilization that negatively impact outcomes for African American patients with multiple myeloma. Health care providers have a role in ameliorating these disparities with thoughtful consideration of historical, sociocultural, individual and disease characteristics that influence the care provided to African American patient population. This review by a group of experts committed to health disparity in multiple myeloma provides a snapshot of disparities at both biologic and non-biologic levels, barriers to clinical care, and best practices to ensure that African American patients receive the best care available.
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Affiliation(s)
- Manisha Bhutani
- Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute/Wake Forest School of Medicine, Charlotte, NC, USA.
| | - Brandon J Blue
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Craig Cole
- Division of Hematology and Oncology, Michigan State University, College of Human Medicine/Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, MI, USA
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Saad Z Usmani
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ajay K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Leon Bernal-Mizrachi
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
- International Myeloma Foundation, Studio City, CA, USA
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5
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Sereda Y, Alarid-Escudero F, Bickell NA, Chang SH, Colditz GA, Hur C, Jalal H, Myers ER, Layne TM, Wang SY, Yeh JM, Trikalinos TA. Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program. J Natl Cancer Inst Monogr 2023; 2023:219-230. [PMID: 37947329 PMCID: PMC11009510 DOI: 10.1093/jncimonographs/lgad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. METHODS Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. DISCUSSION The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.
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Affiliation(s)
- Yuliia Sereda
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hawre Jalal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Tracy M Layne
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute and Center for Scientific Diversity, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Departments of Health Services, Policy, & Practice and of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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Gasoyan H, Fiala MA, Doering M, Vij R, Halpern M, Colditz GA. Disparities in Multiple Myeloma Treatment Patterns in the United States: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e420-e427. [PMID: 37659966 PMCID: PMC10844924 DOI: 10.1016/j.clml.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
We performed a systematic review of the literature investigating the demographic and insurance-related factors linked to disparities in multiple myeloma (MM) care patterns in the United States from 2003 to 2021. Forty-six observational studies were included. Disparities in MM care patterns were reported based on patient race in 76% of studies (34 out of 45 that captured race as a study variable), ethnicity in 60% (12 out of 20), insurance in 77% (17 out of 22), and distance from treating facility, urbanicity, or geographic region in 62% (13 out of 21). A smaller proportion of studies identified disparities in MM care patterns based on other socioeconomic characteristics, with 36% (9 out of 25) identifying disparities based on income estimate or employment status and 43% (6 out of 14) based on language barrier or education-related factors. Sociodemographic characteristics are frequently associated with disparities in care for individuals diagnosed with MM. There is a need for further research regarding modifiable determinants to accessing care such as insurance plan design, patient out-of-pocket costs, preauthorization criteria, as well as social determinants of health. This information can be used to develop actionable strategies for reducing MM health disparities and enhancing timely and high-quality MM care.
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Affiliation(s)
- Hamlet Gasoyan
- Center for Value-Based Care Research, Department of Internal Medicine and Geriatrics, Primary Care Institute, Cleveland Clinic, Cleveland, OH.
| | - Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ravi Vij
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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7
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Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
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Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
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8
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Mian H, Wildes TM, Vij R, Pianko MJ, Major A, Fiala MA. Dynamic frailty risk assessment among older adults with multiple myeloma: A population-based cohort study. Blood Cancer J 2023; 13:76. [PMID: 37164972 PMCID: PMC10172354 DOI: 10.1038/s41408-023-00843-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
Multiple myeloma (MM) is a cancer of older adults and those who are more frail are at high risk of poor outcomes. Current tools for identifying and categorizing frail patients are often static and measured only at the time of diagnosis. The concept of dynamic frailty (i.e. frailty changing over time) is largely unexplored in MM. In our study, adults with newly-diagnosed MM who received novel drugs between the years 2007-2014 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Using a previously published cumulative deficit approach, a frailty index score was calculated at diagnosis and each landmark interval (1-yr, 2-yr, 3-yr post diagnosis). The association of frailty with overall survival (OS) both at baseline and at each landmark interval as well as factors associated with worsening frailty status over time were evaluated. Overall, 4617 patients were included. At baseline, 39% of the patients were categorized as moderately frail or severely frail. Among those who had 3 years of follow-up, frailty categorization changed post diagnosis in 93% of the cohort (78% improved and 72% deteriorated at least at one time point during the follow up period). In a landmark analysis, the predictive ability of frailty at the time of diagnosis decreased over time for OS (Harrell's C Statistic 0.65 at diagnosis, 0.63 at 1-yr, 0.62 at 2-yr, and 0.60 at 3-yr) and was inferior compared to current frailty status at each landmark interval. Our study is one of the first to demonstrate the dynamic nature of frailty among older adults with MM. Frailty may improve or deteriorate over time. Current frailty status is a better predictor of outcomes than frailty status at time of diagnosis, indicating the need for re-measurement in this high-risk patient population.
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Affiliation(s)
- Hira Mian
- Department of Oncology, McMaster University, Hamilton, Canada.
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ravi Vij
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J Pianko
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ajay Major
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark A Fiala
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
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Lucero KT, Obodozie-Ofoegbu OO, Nooruddin Z, Ryan K, Castillo A, Moore AM, Jones X, Frei CR. Health disparity in use of novel agents for first-line therapy in Black and White patients with chronic lymphocytic leukemia in the Department of Veterans Affairs. J Manag Care Spec Pharm 2023; 29:420-430. [PMID: 36989449 PMCID: PMC10387978 DOI: 10.18553/jmcp.2023.29.4.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND: Novel agents (NAs) (ibrutinib, idelalisib, and venetoclax) were first introduced in 2013 as therapeutic options to treat chronic lymphocytic leukemia (CLL). OBJECTIVES: To determine if the uptake of NAs for first-line treatment was similar in Black and White patients with CLL treated in the Department of Veterans Affairs (VA). METHODS: We conducted a retrospective cohort study including adults with CLL managed in the VA from October 1, 2013, to September 30, 2017. Descriptive statistics were used to summarize demographic data, and appropriate bivariable statistical tests were used to compare NA use, baseline characteristics, health outcomes, and complications. A multivariable logistic regression model was used to identify factors associated with uptake of NAs. The study included 565 patients; 86% were White and 14% were Black. Black patients were younger than White patients (median age [66 vs 69 years; P < 0.01]) but had similar median baseline Charlson comorbidity scores (4 vs 5). RESULTS: Overall, Black patients were less likely to receive NAs than White patients (14% vs 26%; P = 0.02). The gap narrowed over the study period: 4% vs 17% (2014), 13% vs 25% (2015), 17% vs 33% (2016), and 31% vs 33% (2017). Black race (P = 0.02) and fiscal year (P < 0.01) were the only variables significantly associated with NA use in the multivariable model. Health outcomes and most complications were similar for Black and White patients despite the difference in prescribing patterns. CONCLUSIONS: This is the first study to identify a potential health disparity with respect to use of NAs among Black and White patients with CLL treated in the VA. Fortunately, health outcomes and most complications were similar for Black and White patients despite the difference in prescribing patterns. DISCLOSURES: Funding for the study was provided by AstraZeneca as a research grant to the Foundation for Advancing Veterans' Health Research (FAVHR), a non-profit entity within the Audie L. Murphy Veterans Hospital, San Antonio, TX. Drs Nooruddin and Frei have received research grants (paid to FAVHR) from AstraZeneca in the last 3 years. Ms Ryan is an employee of AstraZeneca. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the National Institutes of Health, or the authors' affiliated institutions.
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Affiliation(s)
- Kana Tai Lucero
- Long School of Medicine, University of Texas Health San Antonio
- South Texas Veterans Health Care System, San Antonio
| | - Obiageri O Obodozie-Ofoegbu
- Long School of Medicine, University of Texas Health San Antonio
- College of Pharmacy, The University of Texas at Austin, San Antonio
| | - Zohra Nooruddin
- Long School of Medicine, University of Texas Health San Antonio
- South Texas Veterans Health Care System, San Antonio
| | - Kellie Ryan
- AstraZeneca US Medical Affairs, Gaithersburg, MD
| | - Alyssa Castillo
- Long School of Medicine, University of Texas Health San Antonio
- College of Pharmacy, The University of Texas at Austin, San Antonio
| | - Amanda M Moore
- College of Pharmacy, The University of Texas at Austin, San Antonio
| | - Xavier Jones
- Long School of Medicine, University of Texas Health San Antonio
- South Texas Veterans Health Care System, San Antonio
- College of Pharmacy, The University of Texas at Austin, San Antonio
| | - Christopher R Frei
- Long School of Medicine, University of Texas Health San Antonio
- South Texas Veterans Health Care System, San Antonio
- College of Pharmacy, The University of Texas at Austin, San Antonio
- University Health System, San Antonio, TX
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Bhutani M, Lonial S, Mikhael J. Disparities in multiple myeloma among African Americans. J Natl Med Assoc 2022; 115:S26-S31. [PMID: 36566137 DOI: 10.1016/j.jnma.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Sagar Lonial
- Translational Genomics Research Institute, Phoenix, AZ 85004
| | - Joseph Mikhael
- Winship Cancer Institute, Emory University, Atlanta, GA.
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11
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Atrash S, Thompson-Leduc P, Tai MH, Kaila S, Gray K, Ghelerter I, Lafeuille MH, Jayabalan D, Lefebvre P, Rossi A. Patient characteristics, treatment patterns, and outcomes among black and white patients with multiple myeloma initiating daratumumab: A real-world chart review study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e708-e715. [PMID: 35490154 DOI: 10.1016/j.clml.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Daratumumab was approved for multiple myeloma (MM) in 2015. While its safety and efficacy are well documented, there is limited real-world information on its use and outcomes in patients of different races. METHODS We conducted a retrospective chart review of adult patients with MM initiating daratumumab in any line of therapy (LOT) between November 2015 and May 2020. De-identified data were retrieved from 2 US clinical sites; patient characteristics, treatment patterns, and response rate were described for black and white patients, stratified by LOT. Overall response rate (ORR), progression-free survival (PFS), and time to next LOT (TTNT) were compared between black and white patients initiating daratumumab in second line (2L) or later, adjusting for age and number of prior lines. RESULTS Two hundred and fifty-two patient charts (89 black, 163 white) were extracted. Black patients were younger at diagnosis (61.7 vs. 67.0 years) and had a similar proportion of females (black: 44.9%, white: 46.6%). Black patients had longer time between MM diagnosis and daratumumab initiation (43.2 vs. 34.1 months) and received more prior LOTs (median 3.0 vs. 2.0). ORR for black and white patients initiating daratumumab in 1L was 100.0%, with very good partial response or better in 75.0% and 66.7%, respectively. Similar trends were observed in 2L and 3L+. There were no significant differences in ORR, PFS, or TTNT between groups. CONCLUSION Daratumumab had similar clinical outcomes (ORR, PFS, and TTNT) in black and white patients. Black patients initiated daratumumab later in their treatment, suggesting potential discrepancies in access to new MM treatments.
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Affiliation(s)
- Shebli Atrash
- Levine Cancer Institute, Charlotte, NC, United States
| | - Philippe Thompson-Leduc
- Analysis Group Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC H3B 0G7, Canada.
| | - Ming-Hui Tai
- Janssen Scientific Affairs, LLC, Horsham, PA, United States
| | - Shuchita Kaila
- Janssen Scientific Affairs, LLC, Horsham, PA, United States
| | - Kathleen Gray
- Janssen Scientific Affairs, LLC, Horsham, PA, United States
| | - Isabelle Ghelerter
- Analysis Group Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC H3B 0G7, Canada
| | - Marie-Hélène Lafeuille
- Analysis Group Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC H3B 0G7, Canada
| | - David Jayabalan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Patrick Lefebvre
- Analysis Group Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC H3B 0G7, Canada
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, United States
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Dong J, Garacci Z, Buradagunta CS, D'Souza A, Mohan M, Cunningham A, Janz S, Dhakal B, Thrift AP, Hari P. Black patients with multiple myeloma have better survival than white patients when treated equally: a matched cohort study. Blood Cancer J 2022; 12:34. [PMID: 35210395 PMCID: PMC8873507 DOI: 10.1038/s41408-022-00633-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
We assessed differences in survival between non-Hispanic black (NHB) and non-Hispanic white (NHW) patients with multiple myeloma (MM), and the sequential effects of patient characteristics, and diagnosis and treatment-related factors on the survival disparity using data from 3319 NHB and 20,831 NHW MM patients in the SEER-Medicare (1999-2017) database. Four sets of 3319 NHWs were matched sequentially to the same set of 3319 NHBs, based on demographics (age, sex, year of diagnosis, marital status, and SEER site), socioeconomic status (SES, demographics plus SES), presentation factors (SES variables plus comorbidity), and treatment factors (presentation variables plus antimyeloma therapies). We found NHBs were less likely to receive treatment than NHWs even among patients matched for demographics, SES, and comorbidities. The absolute difference in 5-year survival between NHBs and NHWs was not significant in the demographics match (0.6%; P = 0.30) and remained non-significant after matching for SES (1.4%, P = 0.17). When matching for presentation, NHBs had significantly longer 5-year survival than NHWs (absolute difference = 3.8%, P = 0.003). Additional matching on treatment-related factors further enlarged the racial difference in 5-year survival to 4.6% (P < 0.001). Our findings reinforce the importance of equitable access to effective treatment modalities to further improve the survival of NHB patients with MM.
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Affiliation(s)
- Jing Dong
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Zhuping Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Anita D'Souza
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meera Mohan
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashley Cunningham
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Siegfried Janz
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Binod Dhakal
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, and Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Parameswaran Hari
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
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13
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Tang L, Pan Z, Zhang X. The effect of marital status on the survival of patients with multiple myeloma. Hematology 2022; 27:187-197. [PMID: 35068385 DOI: 10.1080/16078454.2022.2026027] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Lina Tang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
| | - Zhenyu Pan
- Department of Pharmacy, Xi'an Children's Hospital, Xi'an, People’s Republic of China
| | - Xiaoxia Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
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Racial and ethnic survival disparities in patients with haematological malignancies in the USA: time to stop ignoring the numbers. THE LANCET HAEMATOLOGY 2021; 8:e947-e954. [DOI: 10.1016/s2352-3026(21)00303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022]
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Yan W, Shi H, He T, Chen J, Wang C, Liao A, Yang W, Wang H. Employment of Artificial Intelligence Based on Routine Laboratory Results for the Early Diagnosis of Multiple Myeloma. Front Oncol 2021; 11:608191. [PMID: 33854961 PMCID: PMC8039367 DOI: 10.3389/fonc.2021.608191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 12/26/2022] Open
Abstract
Objective In order to enhance the detection rate of multiple myeloma and execute an early and more precise disease management, an artificial intelligence assistant diagnosis system is developed. Methods 4,187 routine blood and biochemical examination records were collected from Shengjing Hospital affiliated to China Medical University from January 2010 to January 2020, which include 1,741 records of multiple myeloma (MM) and 2,446 records of non-myeloma (infectious diseases, rheumatic immune system diseases, hepatic diseases and renal diseases). The data set was split into training and test subsets with the ratio of 4:1 while connecting hemoglobin, serum creatinine, serum calcium, immunoglobulin (A, G and M), albumin, total protein, and the ratio of albumin to globulin data. An early assistant diagnostic model of MM was established by Gradient Boosting Decision Tree (GBDT), Support Vector Machine (SVM), Deep Neural Networks (DNN), and Random Forest (RF). Out team calculated the precision and recall of the system. The performance of the diagnostic model was evaluated by using the receiver operating characteristic (ROC) curve. Results By designing the features properly, the typical machine learning algorithms SVM, DNN, RF and GBDT all performed well. GBDT had the highest precision (92.9%), recall (90.0%) and F1 score (0.915) for the myeloma group. The maximized area under the ROC (AUROC) was calculated, and the results of GBDT (AUC: 0.975; 95% confidence interval (CI): 0.963–0.986) outperformed that of SVM, DNN and RF. Conclusion The model established by artificial intelligence derived from routine laboratory results can accurately diagnose MM, which can boost the rate of early diagnosis.
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Affiliation(s)
- Wei Yan
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Hua Shi
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Tao He
- Neusoft Research Institute, Northeastern University, Shenyang, China
| | - Jian Chen
- Neusoft Research Institute, Northeastern University, Shenyang, China
| | - Chen Wang
- Neusoft Research Institute, Northeastern University, Shenyang, China
| | - Aijun Liao
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Wei Yang
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, China
| | - Huihan Wang
- Haematology Department of Shengjing Hospital, China Medical University, Shenyang, China
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