Abstract
Background The treatment options in Multiple Myeloma (MM) are variable and may involve combinations of chemotherapy, immunomodulatory therapy, monoclonal antibodies and stem cell transplant. In the present study, we hypothesized that socioeconomic factors impact the treatment and survival of patients with MM who receive systemic therapy as firstline treatment. Methods We queried the National Cancer Database (NCDB) for patients with MM (ICD-0-3 code 9732) diagnosed from 2004-2016. We included only that received systemic therapy as first line treatment. Active MM patients were defined as those treated within 120 days of diagnosis.
Enrollment rates were calculated as receipt of primary therapy as the incident-event (numerator) over time-to-initiation of therapy or TTI (denominator) and used to calculate incident-rate ratios that was further analyzed using Poisson regression analysis- reported as enrollment-rate ratios (ER, <1 indicating lower enrollment rate). Multivariate Cox-proportional hazard model was performed for survival analysis and reported as calculate Hazard Ratios (HR). IQR=Interquartile range. Results We identified 56,102 patients for enrollment analysis and 50,543 for survival analysis respectively. Median age was 69 (IQR 60-77) years and included 55% males. Overall rate of enrollment to systemic therapy was 42.3 per 1000 person days, mean TTI was 17d (range 6-66d) and median overall survival was 33.4 (11.2-73.5) months. Therapy enrollment in a multivariate model was significiantly impacted by race and gender (p-value<0.005). Advanced age, earlier year of diagnosis, lack of insurance or medicaid insurance, higher comorbidity were associated with higher mortality (HR>1, p-value<0.005) while female gender, non hispanic black race, higher income and treatment at academic center were associated with lower mortality (HR<1, p- value<0.005). Conclusion Study suggests that multiple myeloma patients treated with systemic therapy as first line represent a vulnerable section of the patients and disparities in terms of socioeconomic characteristics exist in the treatment and outcomes.
Citation Format: Thejus Jayakrishnan, Veli Bakalov, Zena Chahine, John Lister, Rodney Wegner, Santhosh Sadashiv. Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-212.
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