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2019 ASCO: Does Insurance Status Impact Survival in Patients With Multiple Myeloma?

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A new study analyzing demographic statistics from the National Cancer Database presented by Chamoun et al at the 2019 ASCO Annual Meeting (Abstract LBA107) identified multiple socioeconomic factors—including private insurance, living in a regionally higher-income area, and receiving treatment in certain practice settings—as being associated with longer survival for patients with multiple myeloma. Furthermore, researchers found that neither race (black or white) nor gender had a significant impact on survival.

“With the continuously increasing cost of health care, it is important to highlight the presence of a survival disadvantage for people who cannot afford their treatment costs,” said lead study author Kamal Chamoun, MD, a fellow with the Hematologic Malignancies and Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Cleveland. “Prices of oral cancer drugs have been rapidly escalating, especially for patients and survivors of multiple myeloma, and we need to take action to limit and reverse the disparity for those who cannot afford private insurance or have lower incomes.”           

Methods

Researchers parsed data from 117,926 patients living with multiple myeloma between 2005 and 2014 from the National Cancer Database. The median age at diagnosis was 67; sex was 55% male and 45% female; 57% of people lived in areas where the median income was under $46,000 per year, and 43% where it was $46,000 or more per year; 52% of people were on Medicare, 35% had private insurance, and 5% were on Medicaid, with 3% being uninsured; and 40% were treated in an academic comprehensive cancer program, 39% in a comprehensive community program, 9% in a community cancer program, and 10% in an integrated network cancer program that offers comprehensive services.

Findings

The researchers assessed data on people for a median of 30 months after treatment. Key results include:

  • Treatment facility: If patients received treatment in an academic institution, they had a 49% greater probability of survival.
  • Income in the region where they were treated: People with a higher median regional income of $46,000 or more had a 16% greater chance of surviving than people with incomes less than $46,000 per year.
  • Private insurance: People with private insurance had a 59% greater probability of survival than those who were insured through Medicaid. Similarly, people with private insurance had a 62% greater probability of survival than those who had no insurance. For people aged 65 and older, those who had private insurance also lived longer than those who had Medicare.
  • Overall health: A lower Charlson comorbidity score was also associated with a greater probability of survival.
  • Distance travelled: A lower percentage of people receiving Medicare or Medicaid traveled more than 120 miles to a treatment facility compared with people with private insurance.

Gender and race (black or white) did not affect survival of people with multiple myeloma in this analysis.

Dr. Chamoun noted that oral cancer medications for multiple myeloma fall under prescription drug plans, and people who are on Medicare may have a harder time affording long-term use of these medications, which can lead to higher rates of treatment interruption or discontinuation. The study did not address this issue directly, but Dr. Chamoun and coauthors postulate that limited access to expensive drugs could explain the study findings.

Next Steps 

There are a number of factors that the researchers hope to explore in future studies, including the possible link between higher costs of care and survival; the medicines used; the types of insurance a person had (HMO, PPO, or other type of plan); and the duration of treatment. The investigators also hope to explore other databases to see if disease-specific information is available that might help further determine who could benefit most from the medicines that come with a high cost.

Disclosure: This study was internally funded at the Seidman Cancer Center. For full disclosures of the study authors, visit coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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