Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities

Sikander Ailawadhi, Ryan D. Frank, Mayank Sharma, Richa Menghani, M'hamed Temkit, Shumail Paulus, Nandita D Khera, Shahrukh Hashmi, Pooja Advani, Abhisek Swaika, Aneel Paulus, Nabeel Aslam, Taimur Sher, Vivek Roy, Gerardo Colon-Otero, Asher A Chanan Khan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted. METHODS: Patients with MM from 1991 to 2010 in the Surveillance, Epidemiology, and End Results-Medicare database were evaluated for racial trends in clinical myeloma-defining events (MDEs), the receipt of treatment (drugs and stem cell transplantation; [SCT]), the cost of care, and overall survival (OS). RESULTS: Among 35,842 patients, the frequency of all MDEs at diagnosis increased over time; whereas, in recent years (2006-2010), all MDEs with the exception of renal dialysis decreased. Blacks had highest rates for all MDEs except bone fractures, which were highest in whites. Over time, the proportion of patients who received any treatment, multiple agents, and SCT increased significantly, and the largest increase was observed in the receipt of immunomodulatory drugs and steroids. There was greater receipt of bortezomib and SCT among whites and blacks and higher receipt of immunomodulatory drugs among Hispanics and Asians (P < .001). Medicare claims were highest during first 6 months after MM diagnosis for blacks and at any time after MM diagnosis for Hispanics. Over time, Medicare claims increased most steadily for Hispanics (P < .001). Hypercalcemia, renal dysfunction, and bone fractures were associated with inferior OS. Blacks and Asians had superior OS compared with whites, but racial differences in OS became less pronounced during 2006 through 2010 (P = .182) compared with prior years (P < .01). Better OS was noted among patients who had higher median incomes. CONCLUSIONS: The current results indicate that there have been significant changes in the management of patients with MM over time and provide an in-depth understanding of the factors that may help explain racial disparities.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Medicare
Multiple Myeloma
Costs and Cost Analysis
Survival
Hispanic Americans
Population
Bone Fractures
Healthcare Disparities
Pharmaceutical Preparations
Hypercalcemia
Stem Cell Transplantation
Renal Dialysis
Epidemiology
Steroids
Databases
Kidney
Therapeutics

Keywords

  • And End Results (SEER)-Medicare
  • Cost
  • Disparity
  • Epidemiology
  • Myeloma
  • Surveillance
  • Trends

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population : A comprehensive look at racial disparities. / Ailawadhi, Sikander; Frank, Ryan D.; Sharma, Mayank; Menghani, Richa; Temkit, M'hamed; Paulus, Shumail; Khera, Nandita D; Hashmi, Shahrukh; Advani, Pooja; Swaika, Abhisek; Paulus, Aneel; Aslam, Nabeel; Sher, Taimur; Roy, Vivek; Colon-Otero, Gerardo; Chanan Khan, Asher A.

In: Cancer, 01.01.2018.

Research output: Contribution to journalArticle

@article{fadd196d6a9d400894ad071aa3bb251e,
title = "Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities",
abstract = "BACKGROUND: Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted. METHODS: Patients with MM from 1991 to 2010 in the Surveillance, Epidemiology, and End Results-Medicare database were evaluated for racial trends in clinical myeloma-defining events (MDEs), the receipt of treatment (drugs and stem cell transplantation; [SCT]), the cost of care, and overall survival (OS). RESULTS: Among 35,842 patients, the frequency of all MDEs at diagnosis increased over time; whereas, in recent years (2006-2010), all MDEs with the exception of renal dialysis decreased. Blacks had highest rates for all MDEs except bone fractures, which were highest in whites. Over time, the proportion of patients who received any treatment, multiple agents, and SCT increased significantly, and the largest increase was observed in the receipt of immunomodulatory drugs and steroids. There was greater receipt of bortezomib and SCT among whites and blacks and higher receipt of immunomodulatory drugs among Hispanics and Asians (P < .001). Medicare claims were highest during first 6 months after MM diagnosis for blacks and at any time after MM diagnosis for Hispanics. Over time, Medicare claims increased most steadily for Hispanics (P < .001). Hypercalcemia, renal dysfunction, and bone fractures were associated with inferior OS. Blacks and Asians had superior OS compared with whites, but racial differences in OS became less pronounced during 2006 through 2010 (P = .182) compared with prior years (P < .01). Better OS was noted among patients who had higher median incomes. CONCLUSIONS: The current results indicate that there have been significant changes in the management of patients with MM over time and provide an in-depth understanding of the factors that may help explain racial disparities.",
keywords = "And End Results (SEER)-Medicare, Cost, Disparity, Epidemiology, Myeloma, Surveillance, Trends",
author = "Sikander Ailawadhi and Frank, {Ryan D.} and Mayank Sharma and Richa Menghani and M'hamed Temkit and Shumail Paulus and Khera, {Nandita D} and Shahrukh Hashmi and Pooja Advani and Abhisek Swaika and Aneel Paulus and Nabeel Aslam and Taimur Sher and Vivek Roy and Gerardo Colon-Otero and {Chanan Khan}, {Asher A}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/cncr.31237",
language = "English (US)",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population

T2 - A comprehensive look at racial disparities

AU - Ailawadhi, Sikander

AU - Frank, Ryan D.

AU - Sharma, Mayank

AU - Menghani, Richa

AU - Temkit, M'hamed

AU - Paulus, Shumail

AU - Khera, Nandita D

AU - Hashmi, Shahrukh

AU - Advani, Pooja

AU - Swaika, Abhisek

AU - Paulus, Aneel

AU - Aslam, Nabeel

AU - Sher, Taimur

AU - Roy, Vivek

AU - Colon-Otero, Gerardo

AU - Chanan Khan, Asher A

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted. METHODS: Patients with MM from 1991 to 2010 in the Surveillance, Epidemiology, and End Results-Medicare database were evaluated for racial trends in clinical myeloma-defining events (MDEs), the receipt of treatment (drugs and stem cell transplantation; [SCT]), the cost of care, and overall survival (OS). RESULTS: Among 35,842 patients, the frequency of all MDEs at diagnosis increased over time; whereas, in recent years (2006-2010), all MDEs with the exception of renal dialysis decreased. Blacks had highest rates for all MDEs except bone fractures, which were highest in whites. Over time, the proportion of patients who received any treatment, multiple agents, and SCT increased significantly, and the largest increase was observed in the receipt of immunomodulatory drugs and steroids. There was greater receipt of bortezomib and SCT among whites and blacks and higher receipt of immunomodulatory drugs among Hispanics and Asians (P < .001). Medicare claims were highest during first 6 months after MM diagnosis for blacks and at any time after MM diagnosis for Hispanics. Over time, Medicare claims increased most steadily for Hispanics (P < .001). Hypercalcemia, renal dysfunction, and bone fractures were associated with inferior OS. Blacks and Asians had superior OS compared with whites, but racial differences in OS became less pronounced during 2006 through 2010 (P = .182) compared with prior years (P < .01). Better OS was noted among patients who had higher median incomes. CONCLUSIONS: The current results indicate that there have been significant changes in the management of patients with MM over time and provide an in-depth understanding of the factors that may help explain racial disparities.

AB - BACKGROUND: Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted. METHODS: Patients with MM from 1991 to 2010 in the Surveillance, Epidemiology, and End Results-Medicare database were evaluated for racial trends in clinical myeloma-defining events (MDEs), the receipt of treatment (drugs and stem cell transplantation; [SCT]), the cost of care, and overall survival (OS). RESULTS: Among 35,842 patients, the frequency of all MDEs at diagnosis increased over time; whereas, in recent years (2006-2010), all MDEs with the exception of renal dialysis decreased. Blacks had highest rates for all MDEs except bone fractures, which were highest in whites. Over time, the proportion of patients who received any treatment, multiple agents, and SCT increased significantly, and the largest increase was observed in the receipt of immunomodulatory drugs and steroids. There was greater receipt of bortezomib and SCT among whites and blacks and higher receipt of immunomodulatory drugs among Hispanics and Asians (P < .001). Medicare claims were highest during first 6 months after MM diagnosis for blacks and at any time after MM diagnosis for Hispanics. Over time, Medicare claims increased most steadily for Hispanics (P < .001). Hypercalcemia, renal dysfunction, and bone fractures were associated with inferior OS. Blacks and Asians had superior OS compared with whites, but racial differences in OS became less pronounced during 2006 through 2010 (P = .182) compared with prior years (P < .01). Better OS was noted among patients who had higher median incomes. CONCLUSIONS: The current results indicate that there have been significant changes in the management of patients with MM over time and provide an in-depth understanding of the factors that may help explain racial disparities.

KW - And End Results (SEER)-Medicare

KW - Cost

KW - Disparity

KW - Epidemiology

KW - Myeloma

KW - Surveillance

KW - Trends

UR - http://www.scopus.com/inward/record.url?scp=85040861751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040861751&partnerID=8YFLogxK

U2 - 10.1002/cncr.31237

DO - 10.1002/cncr.31237

M3 - Article

C2 - 29360160

AN - SCOPUS:85040861751

JO - Cancer

JF - Cancer

SN - 0008-543X

ER -