Supportive Care Lacking in Older Multiple Myeloma Patients

August 12, 2019
Leah Lawrence

Older adults with multiple myeloma are not receiving the recommended care which includes bone-modifying drugs, antiviral prophylaxis, and the influenza vaccine.

Older adults with multiple myeloma in the United States are not receiving the appropriate amount of guideline-recommended supportive care, including bone-modifying drugs, influenza vaccination, and antiviral prophylaxis, according to the results of a new study published in Cancer.

In addition, non-Hispanic Blacks were less likely to received bone-modifying drugs and an influenza vaccination, compared with other groups.

“With improving survival, supportive care use among older adults with multiple myeloma is increasingly important,” wrote researchers led by Smith Giri, MBBS, MHS, of Yale School of Medicine, and colleagues. “The results of our study show significant underutilization of guideline-recommended supportive care, measures focused on bone health, and infection prevention among older adults with multiple myeloma in the United States.”

In the study, Giri and colleagues used data from the Surveillance, Epidemiology, and End Results Medicare database to look at treatment and outcomes among 1,996 patients aged 66 years or older diagnosed with multiple myeloma between 2008 and 2013. All patients had received active treatment and survived 1 year or longer.

Among the patients, only 64% received bone-modifying drugs. Of the bone-modifying drugs received, the majority of patients (80%) received zoledronate. Multivariable analysis showed that patients with preexisting chronic kidney disease (odds ratio [OR]=0.43; P<.01) were less likely to receive bone-modifying drugs.

“Up to 30% of patients with multiple myeloma present with renal insufficiency at diagnosis, and clinicians may hesitate to initiate bisphosphonates in this situation,” the researchers wrote. “However, complete renal recovery quickly occurs in nearly 70% of these patients, and bone-modifying drugs could be initiated thereafter.”

Bone-modifying drugs were also less likely to be distributed among non-Hispanic blacks (OR=0.63; P<.01), patients with increased age at diagnosis (P=.05), patients with a higher comorbidity index and with the use of oral antimyeloma therapy, (OR=0.46; P<.01).

A little more than half (52%) of patients who survived the influenza season after their diagnosis received influenza vaccination. Non-Hispanic blacks also had lower odds of receiving influenza vaccination (OR=0.52; P<.01), as were patients with Medicaid dual coverage (OR=0.76; P=.05).

Finally, fewer than half (49%) of patients receiving proteasome inhibitors received antiviral prophylaxis.

“Patients with significant comorbidities, patients receiving care in the South, and patients receiving care at a physician’s office had lower odds of receiving antiviral agents. Patients with higher comorbidities are generally frail and may be not be deemed to be appropriate candidates for supportive care,” the researchers wrote. “The lower rate of utilization in the setting of a physician’s office may reflect the relative inexperience of providers and provide opportune settings for future interventions.”

Based on these results, use of recommended supportive care in this patient group is “far from ideal”, according to Giri and colleagues.

“This may lead to an unnecessary high symptom burden and poor quality of life among patients,” they concluded.

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