A retrospective cohort study published in Blood Cancer Journal by Gasoyan et al revealed discrepancies between the timing of the initiation of any treatment and the fill of prescriptions for oral antimyeloma medications in patients with multiple myeloma, with a lower likelihood of Black and older individuals receiving the latter at 30 days after diagnosis.
“Disparities in treatment initiation for multiple myeloma vary by demographic characteristics and insurance type,…[but] less is known about disparities in the time to treatment initiation with costly oral antimyeloma medications,” the investigators commented. “Understanding how race and other social determinants of health affect delays in care is critical in planning health policy initiatives and patient navigation programs aimed at achieving equity.”
Study Details
Using data from the Taussig Cancer Center’s Myeloma Patient Registry and electronic health records, the investigators focused on 720 patients (mean age = 67 years; 55% male) who were diagnosed with multiple myeloma between January 2017 and December 2021. Of this population, 77% were White, 22% were Black, and 1% were of another race. A total of 36.0%, 29.0%, 25.0%, 8.3%, and 1.9% of patients were covered by private insurance, traditional Medicare, Medicare Advantage, Medicaid, or were self-paying or covered by another payor, respectively. More than one-third of the study population (37%) resided in an area in the most disadvantaged Area Deprivation Index (ADI) quartile.
The primary outcome measure was the time from diagnosis to the initial fill of a prescription for a U.S. Food and Drug Administration (FDA)-approved oral antimyeloma medication. The time to the receipt of any FDA-approved facility-administered or oral antimyeloma medication was evaluated as a secondary outcome measure. For both, the investigators did not consider the receipt of corticosteroids alone; however, given their initiation in some patients, the time to the receipt of any treatment was also captured. Follow-up data were provided for a median of 765 days (interquartile range = 401–1,280 days).
Primary Outcome
A total of 543 patients (75%) filled a prescription for an oral noncorticosteroid antimyeloma medication, with a median time to fill of 28 days (interquartile range = 15–61 days). The most common initial prescription was for lenalidomide (93.7%), followed by cyclophosphamide (2.6%), pomalidomide (1.7%), ixazomib (1.5%), and thalidomide (0.6%).
Overall, 286 patients (40%) had a filled prescription for an oral noncorticosteroid antimyeloma medication at 30 days after the initial diagnosis. A multivariable Cox regression analysis controlling for relevant sociodemographic and clinical variables revealed that Black race (vs White; adjusted hazard ratio [HR] = 0.61, 95% confidence interval [CI] = 0.42–0.87), older age at diagnosis (adjusted HR per 1 year = 0.97, 95% CI = 0.95–0.98), diagnosis during an inpatient admission (adjusted HR = 0.63, 95% CI = 0.43–0.92), and estimated glomerular filtration rates of up to 29 mL/min/1.73 m2 (vs ≥ 60; adjusted HR = 0.46, 95% CI = 0.29–0.73) were negatively associated with the fill of prescriptions for oral antimyeloma medications at 30 days. According to the investigators, insurance type and ADI quartile were not significant predictors.
Secondary Outcome
During the follow-up period, 666 patients (93%) received either a facility-administered or oral noncorticosteroid antimyeloma medication. The median time to initiation was 15 days (interquartile range = 7–28 days). At 14 days after the initial diagnosis, nearly half of the study population (n = 321; 45%) underwent such treatment; a multivariable Cox regression analysis revealed that sociodemographic variables were not significantly associated with its initiation.
Nearly all patients (n = 695; 97%) received any treatment, including corticosteroids alone, with a median time to initiation of 9 days (interquartile range = 1–20 days). A total of 58% of the study population initiated their treatment with corticosteroids alone.
“Our findings highlight the need to focus on the barriers to simultaneous initiation of all components of guideline-recommended multidrug induction regimens for multiple myeloma and identify patient populations who might be at a higher risk of delayed treatment initiation with oral antimyeloma medications,” the investigators concluded.
Hamlet Gasoyan, PhD, MPH, of Cleveland Clinic, is the corresponding author of the article in Blood Cancer Journal.
Disclosure: The study was funded by a grant from the National Cancer Institute. For full disclosures of the study authors, visit nature.com.
