Timeliness of initial therapy in multiple myeloma: Trends and factors affecting patient care

Vivek Kumar, Muhamad Alhaj-Moustafa, Leyla Bojanini, Taimur Sher, Vivek Roy, Rami Manochakian, Prakash Vishnu, Srilekha Bodepudi, Zan Shareef, Salman Ahmed, Prachi Jani, Aneel Paulus, Ashna Grover, Victoria R. Alegria, Meghna Ailawadhi, Asher Chanan-Khan, Sikander Ailawadhi

Research output: Contribution to journalArticle

Abstract

Multiple myeloma (MM) treatment has advanced significantly over the last 2 decades. In most patients, the disease course has been altered from early fatality to chronic morbidity with multiple lines of treatment. The MM treatment paradigm has shifted toward treating patients before end-organ damage occurs. Thus, timeliness of treatment initiation in this era might improve patient outcomes. This is the first report to our knowledge analyzing disparities and trends in treatment timeliness of patients with MM using the National Cancer Database. Multiple factors affected the timing of treatment initiation in MM and disparities were found. We noted that initiation of treatment was delayed in women (odds ratio [OR], 1.15; 95% CI, 1.1 to 1.2) and blacks (OR, 1.21; 95% CI, 1.14 to 1.28; reference, whites) and in patients diagnosed in more recent years (2012-2015; OR, 1.15; 95% CI, 1.1 to 1.22; reference, 2004-2007). Patients were likely to start treatment earlier if they were age ≥80 years (OR, 0.83; 95% CI, 0.76 to 0.9; reference, age < 60 years), were uninsured (OR, 0.81; 95% CI, 0.72 to 0.91; reference, private insurance), had Medicaid (OR, 0.87; 95% CI, 0.79 to 0.95; reference, private insurance), were treated in a comprehensive community cancer program (OR, 0.7; 95% CI, 0.65 to 0.77; reference, community cancer program), lived in a location other than the US Northeast, or had a higher Charlson comorbidity score. Patient education and income levels did not affect time to treatment initiation. Particular aspects of these disparities could be explained by our current health care system and insurance rules, whereas others need to be investigated more deeply.

Original languageEnglish (US)
Pages (from-to)E341-E349
JournalJournal of oncology practice
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2020

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

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    Kumar, V., Alhaj-Moustafa, M., Bojanini, L., Sher, T., Roy, V., Manochakian, R., Vishnu, P., Bodepudi, S., Shareef, Z., Ahmed, S., Jani, P., Paulus, A., Grover, A., Alegria, V. R., Ailawadhi, M., Chanan-Khan, A., & Ailawadhi, S. (2020). Timeliness of initial therapy in multiple myeloma: Trends and factors affecting patient care. Journal of oncology practice, 16(4), E341-E349. https://doi.org/10.1200/JOP.19.00309