African American and Hispanic patients with multiple myeloma generally start treatment with novel therapy significantly later than white patients, according to a study published by Ailawadhi et al in Blood Advances. The study found that, on average, it took about 3 months for white patients to start novel therapy after diagnosis, while for both African American and Hispanic patients, it took about 5 months.

“We noted that [minority patients] are not getting introduced to treatment early enough to derive adequate clinical gains."

— Sikander Ailawadhi, MD

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Time between diagnosis and treatment initiation is crucial for patients with multiple myeloma. If treatment is delayed, patients can suffer organ damage, kidney dysfunction, anemia, skeletal fractures, infections, and other serious conditions. Best practice is to start patients on immunomodulatory drugs such as lenalidomide and/or proteasome inhibitors such as bortezomib and carfilzomib. The use of these therapies has more than doubled survival of patients with multiple myeloma within the past decade.

“We noted that [minority patients] are not getting introduced to treatment early enough to derive adequate clinical gains,” said lead study author Sikander Ailawadhi, MD, of Mayo Clinic Florida. “Since our analysis is based on Medicare patient data, these disparities cannot be attributed to differences in insurance coverage. Patients are not receiving treatment equally, even in this ostensibly equal-access setting.”

Methods and Findings

Researchers reviewed data from the Surveillance Epidemiology and End Results (SEER)–Medicare database from 2007 to 2013. The study included 3,504 white patients, 858 African American patients, and 468 Hispanic patients. 

Their analysis found that the average length of time between multiple myeloma diagnosis and start of treatment for white patients was 2.7 months, compared to 4.6 months for Hispanics and 5.2 months for African Americans. Rates of autologous stem cell transplant within 1 year of diagnosis—considered the standard of care for eligible patients—rose among whites and African Americans, but not among Hispanics.

Although this study found that median overall survival was similar across all groups, comparison to previous studies suggests the survival rate for African American patients in particular has not increased as much as it could have with equal and timely access to treatment. The authors suggest the delay in treatment initiation may have inhibited African American patients’ normally better survival outcome, but this would have to be confirmed in another study.

One encouraging observation in the study was the increasing trend of initiating these therapies within the first 6 months of multiple myeloma diagnosis for all three race/ethnicity cohorts over the duration of the study. However, this increase was more pronounced among white and Hispanic patients compared with African American patients.

The study also found that medical costs were highest among Hispanic patients. The total monthly medical costs for whites averaged $10,143 vs $11,546 for African Americans and $12,657 for Hispanics. Researchers suggest the higher cost could be due in part to higher hospitalization costs, possibly incurred as a result of complications due to delayed treatment.

“While future research is needed to investigate possible causes for the observed racial disparities, we hope that understanding and addressing them will lead to more equitable health-care access, cost, and outcome profiles for all [patients with] multiple myeloma, regardless of race or ethnicity,” concluded Dr. Ailawadhi.

Disclosure: For full disclosures of the study authors, visit ashpublications.org.