Race, Insurance Status Impact Receipt of Multiple Myeloma Treatment

There were varying rates of underuse of effective treatments for multiple myeloma (MM) in a single institution that served an inner-city patient population. Older age and sicker patients had higher rates of underuse, and race/ethnicity had varying effects, according to researchers.

The retrospective study, published in Cancer Epidemiology, included data on 1,002 patients with MM treated at a tertiary referral center. The researchers used standard guidelines as a reference in order to identify underuse of effective MM treatments. Of the included patients, 22% of patients identified their race/ethnicity as “other”.

Induction underuse was 7.7% with the highest rate of underuse in patients with other or non-Hispanic white background. Multivariable model showed that other race/ethnicity, age ≥80 years, and unknown primary payer were significant predictors of induction underuse.

“We were surprised to even find a small proportion of induction underuse,” the researchers wrote. “It is possible that this is an overestimate of actual underuse as some patients may have gone to outside institutions for their induction therapy.”

About one-third of patients eligible for stem cell transplant did not undergo the procedure. Multivariable model showed other race/ethnicity, and age group 65–80 years as significant predictors of underuse of this treatment modality.

About one in 10 eligible patients did not receive maintenance therapy. This underuse was highest in patients aged 45–60 years, non-Hispanic Black and Hispanic patients, and patients holding private insurance. Non-Hispanic Black race and Medicaid insurance emerged as significant predictors of underuse of maintenance therapy. The researchers noted that “Medicaid protected against underuse of this expensive therapy and Black patients in our study were much less likely than Hispanics or Asians to have Medicaid.”

Overall, underuse of maintenance therapy (adjusted odds ratio [aOR], 1.98) and interruptions in treatment were associated with a patient’s race/ethnicity and insurance (aOR, 4.14).

“The fact that race-ethnicity independently affected underuse suggests that patients and/or physicians’ beliefs and circumstances may exert an effect beyond access to care,” the researchers wrote. “Fortunately, these underuse episodes did not translate into worse survival.”