Why would there be a difference in the way doctors treat patients based on their race? Among people diagnosed with multiple myeloma in the United States, blacks and Hispanics receive their first treatment about 3 months later than white people, according to a new study that investigated this question.1
The results of the study were recently published in Blood Advances, a publication of the American Society of Hematology. The lead investigator of the study, Sikander Ailawadhi, MD, an oncologist with the Mayo Clinic in Jacksonville, Florida, recently discussed the results of the study.
“We noted that minorities are not getting introduced to treatment early enough to derive adequate clinical gains,” Dr. Ailawadhi said in a statement. “Since our analysis is based on Medicare patient data, these disparities cannot be attributed to differences in insurance coverage. Patients are not receiving treatment equally, even in this ostensibly equal-access setting,” he emphasized.2 Medicare patients have similar expenses for medical treatments, so cost should not be a factor in deciding what treatment to use.
Multiple myeloma is a relatively rare type of blood cancer, and it is more common in men than in women, and more in blacks than in whites, although the survival is longer in blacks than in whites overall. In 2018, approximately 30,770 new cases of multiple myeloma were diagnosed in the United States and approximately 12,770 deaths were attributed to this type of cancer.2
When it comes to the treatment of patients with multiple myeloma, receiving effective treatment early is important for the prevention of medical complications.
Delayed treatment of this type of cancer can lead to anemia, infections, kidney dysfunction, and other complications.
Older studies with old data have shown that racial disparities in the treatment of patients with multiple myeloma are common in terms of access to effective treatment, such as joining clinical trials with newer therapies. Therefore, the researchers of this study wanted to use the most recent information available today to see if things have changed and establish whether all patients with multiple myeloma are now receiving effective medications soon after their diagnosis.
Newer Treatments for Multiple Myeloma
In the past few years, many newer types of medications have been approved by the FDA and have helped to improve outcomes for patients with this blood cancer. Although no cure is yet available for multiple myeloma, if treated early with one of the newer treatments available today, multiple myeloma can remain in remission (no sign of disease) for a long time. Indeed, many patients can live full and productive lives with this cancer for many years.
Conventional treatments for multiple myeloma include chemotherapy, radiation therapy, and autologous stem-cell transplant (ASCT). But in the past decade, novel treatments, such as the immunomodulatory drugs Revlimid (lenalidomide) and Pomalyst (pomalidomide) and the proteasome inhibitors Velcade (bortezomib) and Kyprolis (carfilzomib), have increased the treatment options for patients with multiple myeloma, according to the researchers.2
Furthermore, earlier exposure to and greater use of these novel drugs have improved the outcomes for patients with multiple myeloma and have extended patient survival by almost double what it was in the past decade. Therefore, the current treatment guidelines, including those from the National Comprehensive Cancer Network, which is used by many oncologists, now recommend the use of combination therapies that include bortezomib and/or lenalidomide for first line treatment for patients with newly diagnosed multiple myeloma, and combinations that include pomalidomide and carfilzomib for patients with relapsed or refractory multiple myeloma.
The most recent novel treatments include the CD38 antibody Darzalex (daratumumab), the SLAMF7-directed immunostimulatory antibody Empliciti (elotuzumab), the oral proteasome inhibitor Ninlaro (ixazomib), and the newest selective inhibitor of nuclear expert Xpovio (selinexor).
These medications are mostly used in combination with other drugs for relapsed or refractory disease, to improve patient outcomes by combining the benefits of different types of drugs. For example, daratumumab was approved in September 2019, for first-line treatment, in combination with bortezomib, thalidomide, and dexamethasone, of patients who are eligible for a transplant (ASCT), and in June it was approved, in combination with lenalidomide and dexamethasone, as first-line treatment for patients who are not eligible for a transplant.
For patients who are eligible to have a transplant, ASCT remains the standard of care because it provides a larger benefit when used earlier in the treatment than later.
What the New Data Show
The new study included the latest data to see if the gap between the racial groups has decreased with the addition of these new treatment options in the past decade. With all these treatment options, it would seem reasonable to expect that it will be easier for patients to receive the most appropriate treatments today. The study was based on information from a national Medicare database (called SEER) between 2007 and 2013 and included 3504 white patients with multiple myeloma, 858 black patients, and 468 Hispanics.1
Mixed results. The results of the study show that although the use of novel therapies increased among the 3 racial groups, black and Hispanic patients received novel therapies later than white patients after being diagnosed with multiple myeloma. Although the use of novel therapies increased over time among all racial groups, this increase was greater among white patients than among black or Hispanic patients.
In addition, the use of a transplant, or ASCT, within 1 year of being diagnosed with multiple myeloma, which is recommended for all eligible patients, increased for white and black patients, but not for Hispanic patients. The use of a transplant by eligible patients provides the most benefits when used within the first year of diagnosis.
The good news. A positive finding in this study was that overall, there is a tendency to start treatments for patients within the first 6 months of diagnosis, but again this was more common for white and Hispanic patients than for black patients.
Who Pays More?
The results of the study also show that the cost of treatment was highest among Hispanic patients. On average, the total medical costs for white patients was $10,143 per month compared with $11,546 for black patients and $12,657 for Hispanic patients. The researchers suggest that the increased costs for blacks and Hispanics could in part result from higher rates of hospitalizations, which are associated with high costs.
The higher hospitalization rates for black and Hispanic patients are probably the result of the complications from their cancer that were caused by the delay in treatment, according to the researchers. They hope that understanding the gaps that exist in the use of effective treatments for different patients will help to close this racial gap in the treatment of multiple myeloma.
“While future research is needed to investigate possible causes for the observed racial disparities, we hope that understanding and addressing them will lead to more equitable healthcare access, cost, and outcome profiles for all multiple myeloma patients, regardless of race or ethnicity,” Dr. Ailawadhi said.
- A new study shows significant racial discrepancies in the treatment of patients with multiple myeloma
- All patients with multiple myeloma should start treatment within the first 6 months of diagnosis to gain the most benefit
- For eligible patients with multiple myeloma, stem-cell transplant provides the most benefit when used within the first year of diagnosis
- Make sure you receive effective treatment early to prevent medical complications, such as anemia, infections, and kidney dysfunction
- Delaying effective treatment in multiple myeloma can cause complications and hospitalization, which will also increase your out-of-pocket costs
- Ailawadhi S, Parikh K, Abouzaid S, et al. Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: a SEER-Medicare analysis. Blood Advances. 2019;3:2986-2994.
- American Society of Hematology. Study finds racial disparities in the treatment of multiple myeloma patients. Press release. October 17, 2019 www.hematology.org/Newsroom/Press-Releases/2019/9972.aspx.
International Myeloma Foundation
Multiple Myeloma Research Foundation
National Cancer Institute