Socioeconomic Status Has Significant Impact on Multiple Myeloma Survival Globally

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

A synthesis of P-values across 16 studies in different global regions found that socioeconomic status continues to be a significant prognostic factor of overall survival for patients with multiple myeloma.

For patients with multiple myeloma, socioeconomic status remains a strong prognostic factor of overall survival (OS) globally and continues to act as a barrier to equitable care, according to results from a literature review and synthesis of studies published in the Mediterranean Journal of Hematology and Infectious Diseases.

The meta-analysis included a synthesis of hazard ratios (HRs) from 10 global studies that included 85,198 patients with multiple myeloma, which were weighted to a sample size of each study and adoption of the hypothesis of random effect, yielding a combined HR of 1.26 (95% CI, 1.13-1.31); the HR favored those with a high socioeconomic status. Survival probability for patients with a high SES was 1.26 times higher compared with patients of a low socioeconomic status.

“[Socioeconomic status] is an established poor prognostic factor for survival in many cancers,” the investigators wrote. “Differences in [socioeconomic status] are a surrogate marker reflecting other factors like ethnicity/race, insurance [coverage], place of living, accessibility to health services, etc.”

A 5-year OS rate was assessed across both high– and low–socioeconomic status groups and included a total of 134,363 patients with multiple myeloma. Results of the study were broken down by geographic location. A total of 16 studies were included in the overall analyses.

For the United States, 6 studies were analyzed of which P-values were synthesized. The 6 studies included a total of 89,807 patients, with investigators reporting a P-value of less than .0001. The results suggest a statistically significant association in the United States between low SES and OS across age groups and decades.

SEER registry reporting data, which included over 30,000 patients with myeloma who had been diagnosed within the United States from 1981 to 2010, highlighted a gap in survival rates according to socioeconomic status, which appear to have gotten worse over time. This gap in outcomes was further confirmed by Kaplan-Meier survival analyses, which identified P-values of .0016 within the last decade as more effective treatment options became available. Additionally, in 1 dataset that included 10,161 patients with multiple myeloma who had been diagnosed from 2007 to 2012 under 65 years of age, investigators reported that marital status, insurance status, and country-level income had a significant impact on OS. The multivariable analysis indicated that the cumulative sociodemographic factors were statistically significantly associated with worse survival. Patients with 1, 2, 3, and 4 adverse sociodemographic factors had 4-year OS rates of 71.1%, 63.2%, 53.4%, and 46.5%, respectively.

Another dataset of 562 patients indicated that those with a high socioeconomic status were less likely to have comorbid conditions (58%) compared with those of middle (72%) and low (76%) socioeconomic statuses (P = .007). Additionally, those with a high socioeconomic status were also more likely to have private insurance and undergo allogenic stem cell transplant (ASCT; 72% vs 59% vs 52%) compared with those of middle and low socioeconomic statuses, respectively. Socioeconomic status, age of diagnosis, year of diagnosis, race, comorbidities, treatment with ASCT, and insurance provider all appeared to have independent associations with survival.

In Australia and New Zealand, categorized as “Oceania,” 3 studies were featured with a total of 10,196 patients. In a synthesis of 2 cohorts from Australia and 1 from New Zealand, SES was found to be a prognostic factor for survival, supported by a P-value of .022.

Findings from the New Zealand study that took place between 2004 and 2016 found that age (HR, 1.06; 95% CI, 1.05-1.07), socioeconomic deprivation (HR, 1.10; 95% CI, 1.04-1.16), and 4 regions of the country (HR, 1.12; 95% CI, 1.05-1.19) were negative independent prognostic factors for OS, whereas treatment with ASCT (HR, 0.66; 95% CI, 0.51-0.87) or bortezomib (HR, 0.74; 95% CI, 0.64-0.86) was a positive factor.

Three European studies were included that took place in the United Kingdom and Greece with 18,533 patients. The P-value from the synthesized analysis was less than .0001, supporting the fact that socioeconomic status appears to be an important prognostic factor for survival in the Europe, as well.

A dataset that included 10,015 patients in the United Kingdom diagnosed between 1985 and 2004 identified a trend towards higher survival among patients in the most affluent areas who were diagnosed in the era of targeted therapies from 2000 to 2004.

Lastly, Asia included 915 patients across 2 studies in the synthesized P-value analysis. The P-value was less than .0001 and showed that improved survival outcomes were associated with patients of a higher socioeconomic status compared with patients of a lower socioeconomic status.

The investigators concluded that the financial toxicity surrounding multiple myeloma care is increasing for both health system payers and patients. Moreover, the disparities will continue to widen over time due to the inability to meet the need for continuous administration of expensive therapies.

Reference

Intzes S, Symeonidou M, Zagoridis K, et al. Socioeconomic status is globally a prognostic factor for overall survival of multiple myeloma patients: synthesis of studies and review of the literature. Mediterr J Hematol Infect Dis. 2021;13(1):e2021006. doi:10.4084/MJHID.2021.006