Factors such as insurance status and being married are significant determinants of survival compared with race/ethnicity, in patients with multiple myeloma who are less than 65 years of age.
Three new drugs for multiple myeloma (MM) were
, creating a surplus of available options for physicians to choose combinations treatments. However, factors beyond the treatment regimen influence survival in these patients, according to a new study published in the journal
The retrospective analysis used overall survival (OS) data from the Surveillance, Epidemiology, and End Results (SEER-18) program for patients younger than 65 years who were diagnosed with MM between 2007 and 2012. The hypothesis of the study was that sociodemographic factors—marital status (other than married), insurance status (uninsured or Medicaid insured), median household income, and education—that were adjusted for race and ethnicity influenced the survival of these patients. Participants were categorized as Hispanic, non-Hispanic black, non-Hispanic white, and others.
The study included over 10,000 cases of MM that had a median follow-up period of 27 months (range was 0 to 71 months). Depending on whether the patient had 0, 1, 2, or 3 adverse sociodemographic factors, the 4-year OS rate was estimated at 71.1%, 63.2%, 53.4%, and 46.5% (<.001). Hispanic and non-Hispanic black patients had more adverse sociodemographic factors and worse OS, the authors report, but the association was lost following adjustment for confounders, they write.
This led the authors to conclude that sociodemographic factors are a much stronger determinant of survival in patients with multiple myeloma who are younger than 65 years of age.
“This finding strongly suggests that there is a huge disparity in outcomes that could potentially be overcome by improving access and affordability of treatments,” said Luciano Costa, MD, PhD, of the University of Alabama at Birmingham, lead author of the study. “With the recent emphasis on comparative effectiveness in oncology, it also becomes crucial that all variables affecting outcomes—including sociodemographic factors—are accounted for when comparisons between different therapeutic approaches and health care systems are made,” he added.
Costa LJ, Brill IK, Brown EE. Impact of marital status, insurance status, income, and race/ethnicity on the survival of younger patients diagnosed with multiple myeloma in the United States [published online August 22, 2016]. . doi: 10.1002/cncr.30183.