African-American Patients with Multiple Myeloma Less Likely to Receive Palliative Radiotherapy

Despite having a high incidence of and mortality from multiple myeloma (MM), African American patients were less likely to receive palliative radiotherapy within 1 year of their diagnosis, according to a study published in Leukemia & Lymphoma.

Palliative radiotherapy is a standard treatment for painful bone metastases associated with MM. Previous studies have shown disparities in initial systemic treatment of MM negatively affecting disease control and outcomes for African-American patients.

In this study, the researchers assessed whether racial disparities exist in the use of palliative radiotherapy for MM using data from 173,556 patients diagnosed with MM from 2004 to 2016 from the National Cancer Database. Of these patients 13.7% met the criteria for palliative radiation with a total dose of greater than 4-30 Gy within 1 year of diagnosis. Of the included patients, 15.5% with non-Hispanic white, 14.3% were African American, 15.8% were Hispanic, and 14.4% were “other”.

The researchers found that African American patients were 13% less likely to receive radiotherapy within the first year of diagnosis (odds ratio=0.87; 95% CI, 0.83-0.90) compared with non-Hispanic whites.

“These findings are consistent with an expanding body of knowledge that pain and other symptoms are not adequately addressed in AA patients compared to NHWs across various healthcare settings,” the researchers wrote. “Despite this relatively small absolute difference in RT use, we believe these findings are clinically significant in the context of an MM landscape permeated by known racial disparities in treatment and outcomes.”

Additionally, decreased receipt of radiation was associated with older age, female sex, higher comorbidity score, living more than 12.5 miles from the treatment facility, having Medicare or private insurance, and living in areas with the highest median income bracket.

Increased odds of receiving radiation therapy was associated with living in an urban or rural community (compared with a metro community), other government insurance, and receipt of chemotherapy.

The study also found that compared with non-Hispanic whites, African American patients were 18% less likely to die within 30 days of initiating palliative radiotherapy (OR=0.82; 95% CI, 0.67-0.995). This finding, the researchers wrote, may “suggest a decreased tendency to treat these patients at the end of life.”