Newly presented data reveal disparities between Black and White patients in both the characteristics of and the decision-making around treatment for chronic lymphocytic leukemia (CLL) and multiple myeloma, respectively.
Newly presented data reveal disparities between Black and White patients in both the characteristics of and the decision-making around treatment for chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), respectively.
Both posters were presented at the European Hematology Association 2023 Annual Congress, held in Frankfurt, Germany, from June 8-11, 2023.
The researchers of the first poster, looking at treatment patterns in CLL, cited recent study findings showing poorer clinical outcomes in Black patients with CLL diagnosed between 2004 and 2018 as the impetus for their work.1 They used data from the CLL Collaborative Study of Real-World Evidence, which includes 19 American treatment centers, in their analysis of Black and White adult patients with CLL who initiated first-line therapy on or after January 1, 2014.
Of the 979 patients, 110 (11.2%) were Black and 869 (88.8%) were White. At baseline, Black patients were younger, had a greater comorbidity burden, and were more likely to have Medicaid coverage, have no insurance, and lack pharmacy benefits.
Black patients started first-line therapy sooner after their CLL diagnosis compared with White patients, but that initial line of therapy was less likely to include a targeted agent and more likely to include chemotherapy or chemoimmunotherapy; more Black patients than White patients received their first targeted agent in the second line of therapy. Black patients were also more likely to receive only 1 line of treatment and to not receive a targeted agent at all during follow-up.
Median progression-free survival (PFS) was 14.8 months shorter for Black patients vs White patients (28.5 months vs 43.3 months).
After weighting for several clinical and demographic characteristics, including sex, age, insurance type, and comorbidities, this disparity in PFS was attenuated. The racial gap was also closed when examining only those who started their first line of therapy in 2017-2022, suggesting that disparities may hopefully have begun narrowing in recent years.
“These data suggest that access to adequate CLL care with more effective targeted treatments may help to reduce the many racial disparities and large comorbidity burden for patients in real-world clinical practice,” the poster authors concluded. They also called attention to the importance of ensuring equitable representation of patients from diverse backgrounds in clinical trials.
Another poster took a deep dive into the factors that go into treatment decision-making as reported by patients with MM.2 The investigators offered online survey participation to patients active on Inspire, a closed online health community, making sure to recruit a racially and ethnically diverse sample of patients. Participants were asked questions on their involvement with treatment selection (both actual and preferred), their perceived importance of treatment attributes, determinants of their next potential treatment decision, and sources of information on MM treatment.
A total of 126 patients completed the survey; 86 (68%) identified as White and 30 (24%) as Black. Of note, White patients were more likely than Black patients to be referred to an MM specialist as soon as they received their diagnosis (56% vs 40%), whereas Black patients more often reported receiving a specialist referral after their first or second MM relapse (33% vs 9%).
Black patients were more likely to prefer their doctor to take the lead on their treatment decision, but in actuality physicians took a greater role than preferred for Black patients, as 60% reported feeling that the physician made the final decision on their treatment.
Some factors contributing to treatment decision-making were similarly important to both groups, but some differed, with Black patients more likely to place importance on their family history, other non-MM illnesses, and complementary treatments. Black patients were more likely than White patients to rank nonphysician sources of information as more impactful on their treatment decisions.
“The findings suggest that physicians may demonstrate some bias by assuming a greater role in decision-making with Black patients, rather than engaging in shared involvement with them to arrive at a treatment decision,” the poster investigators wrote. “Physicians’ bias may also delay Black patients from being referred to an MM specialist and may increase their likelihood of getting a second opinion.”
They called for treatment optimization efforts that account for patients’ values and preferences in determining the therapy journey.
1. Rhodes JM, Shadman M, Lamanna N, et al. Racial disparities in real-world treatment patterns and outcomes among patients with CLL. Poster presented at: European Hematology Association 2023 Congress; June 8-11, 2023; Frankfurt, Germany. Poster P647.
2. Dwyer LL, Lin D, Wu B, et al. Racial differences in determinants of treatment decision making among patients with multiple myeloma. Poster presented at: European Hematology Association 2023 Congress; June 8-11, 2023; Frankfurt, Germany. Poster P1681.