Location and Insurance Matter When It Comes to Survival in Multiple Myeloma

Research presented at ASCO 2019 posited that multiple socioeconomic factors make a real difference in overall survival.

CHICAGO–Multiple socioeconomic factors, including private insurance and living in a regionally higher-income area may affect overall survival (OS) rates among patients with multiple myeloma, according to research (abstract LBA107) presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, held May 31–June 4 in Chicago. Researchers also found that receiving treatment in certain practice settings may be associated with longer survival. However, neither race (black or white) nor gender had a significant impact on survival.

Lead study author Kamal Chamoun, MD, a fellow at the Hematologic Malignancies and Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Cleveland, Ohio, said that with the continuously increasing cost of healthcare, it is important to highlight the presence of a survival disadvantage for individuals who cannot afford treatment costs. The cost of oral cancer drugs has been rapidly escalating, especially for patients with multiple myeloma as well as survivors of the disease. One study showed that 17% of patients with multiple myeloma report delays in treatment, with about 12% report filling only part of their prescription, and 10% reporting discontinuing treatment due to elevated costs, he said.

There is a need to take action to limit and reverse the disparity for those who cannot afford private insurance or who have lower incomes, Chamoun said. “The proportion of the treatment costs attributed to medications has nearly tripled from the year 2014. Most importantly, another study has shown that out-of-pocket costs for patients with Medicare is significantly higher than patients with other types of insurance. This does not only affect the quality of life for patients, but also affects adherence to medications,” said Chamoun.

The researchers analyzed National Cancer Database data from 117,926 people living with multiple myeloma (median age at diagnosis, 67 years) between 2005 and 2014. They looked at demographic factors, including gender (55% male; 45% female). Wen it came to income by region, 57% of individuals lived in areas where the median income was less than $46,000 per year, and 43% lived in areas where it was $46,000 or more per year.

Regarding the patients' primary insurance, 52% were on Medicare, 35% had private insurance, 5% were on Medicaid, and 3% were uninsured. The study showed that 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.

After assessing how well patients were doing after a median of 30 months post-treatment, the researchers found that individuals receiving treatment in an academic institution had a 49% greater probability of survival. Income in the region in which they were treated appeared to matter: those with a higher median regional income of $46,000 or higher had a 16% greater chance of surviving than individuals with an income of less than $46,000 per year.

Patients with private insurance had a 59% greater probability of survival than those who were insured through Medicaid. In addition, individuals with private insurance had a 62% greater probability of survival than those who had no insurance. Those with private insurance also lived longer than those with Medicare when the researchers looked at adults over the age of 65 years. In terms of overall health, lower Charlson Comorbidity scores was associated with a greater probability of survival.

Chamoun noted that oral cancer medications for multiple myeloma fall under prescription drug plans, and patients who are on Medicare may have a harder time affording long-term use of these medications, leading to higher rates of treatment interruption or discontinuation. Chamoun and coauthors postulate that limited access to expensive drugs may, in part, explain the study findings. Even though patients on Medicaid have all their medical expenses covered, they often lack strong social support networks to provide transportation or other nonmedical assistance, according to the authors.