Summary
Multiple socioeconomic factors, including private insurance, living in a regionally higher-income area, and receiving treatment in certain practice settings, leads to longer survival for multiple myeloma patients.
Multiple myeloma has become the number one cancer treated with oral oncologic medications. The proportion of the treatment costs attributed to medications nearly tripled from 2000 to 2014. The prices of immunomodulators, such as lenalidomide, which are commonly used to treat multiple myeloma, have risen rapidly over the past decade. Other oral medicines, such as the oral proteasome inhibitor ixazomib and histone deacetylase inhibitor panobinostat, are also expensive, but are less commonly used.
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Original Article
Socioeconomic Factors Predict Long-Term Survival in Multiple Myeloma
Oncology Times
By Mark L. Fuerst
Multiple socioeconomic factors, including private insurance, living in a regionally higher-income area, and receiving treatment in certain practice settings, leads to longer survival for multiple myeloma patients.
Multiple myeloma has become the number one cancer treated with oral oncologic medications. The proportion of the treatment costs attributed to medications nearly tripled from 2000 to 2014. The prices of immunomodulators, such as lenalidomide, which are commonly used to treat multiple myeloma, have risen rapidly over the past decade. Other oral medicines, such as the oral proteasome inhibitor ixazomib and histone deacetylase inhibitor panobinostat, are also expensive, but are less commonly used.
“With the continuously increasing cost of health care, it is important to highlight the presence of a survival disadvantage for people who cannot afford their treatment costs,” said lead author Kamal Chamoun, MD, a Fellow with the Hematologic Malignancies and Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Cleveland. “Prices of oral cancer drugs have been rapidly escalating, especially for patients and survivors of multiple myeloma, and we need to take action to limit and reverse the disparity for those who cannot afford private insurance or have lower incomes.”
Chamoun presented the results of the study at a press briefing at the 2019 ASCO Annual Meeting (Abstract LBA107).
About the Study
Researchers parsed data from 117,926 multiple myeloma patients, median age 67 years at diagnosis, between 2005 and 2014 from the National Cancer Database, representing 70 percent of all new cases of all types of cancer. Other demographic factors evaluated included gender (55% male, 45% female); income by region (57% of people lived in areas where the median income was under $46,000 per year, while 43% had a median regional income of $46,000 or more per year); primary insurance (52% of patients were on Medicare, 35% had private insurance, and 5% were on Medicaid, with 3% being uninsured); and practice setting (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).
Key Findings
After an assessment of data for a median of 30 months after treatment, the researchers found the following:
- If patients received treatment in an academic institution, they had a 49 percent greater probability of survival.
- Patients with a higher median regional income of $46,000 or more had a 16 percent greater chance of surviving than people with incomes less than $46,000 per year.
- Patients with private insurance had a 59 percent greater probability of survival than those who were insured through Medicaid. Similarly, people with private insurance had a 62 percent greater probability of survival than those who had no insurance. For people age 65 and older, those who had private insurance also lived longer than those who had Medicare.
- Lower Charlson Comorbidity Index scores, which predict risk of death within 1 year of hospitalization for people with 19 different comorbid conditions, was associated with a greater probability of survival.
- A lower percentage of people receiving Medicare or Medicaid travelled more than 120 miles to a treatment facility compared with people with private insurance.
Gender and race (black or white) did not affect survival in this analysis.
The study’s limitations, said Chamoun, include that it was retrospective with no disease specific characteristics and no specific information on treatment received, and no information on subtype of insurance.
Chamoun noted that oral cancer medications for multiple myeloma fall under prescription drug plans and those who are on Medicare may have a harder time affording long-term medications. This can lead to higher rates of treatment interruption or discontinuation. The study did not address this issue directly, but the researchers suggest that limited access to expensive drugs could help explain the study’s findings.
Although patients on Medicaid will have all their medical expenses covered, they also need and often lack strong social support networks to provide transportation or other non-medical assistance. Intense care is often needed on a regular basis, and this care could be limited for those in rural settings who often have to travel 200 miles roundtrip to a primary care facility.
Next Steps
The researchers hope to explore a number of factors in the future, including the possible link between higher costs of care and survival, the medicines specifically used, type of insurance (HMO, PPO, or other type of plan), and duration of treatment. They also hope to use other databases to determine whether disease-specific information might help further identify which patients could benefit the most from high-cost medications.
ASCO Expert Catherine Diefenbach, MD, Director of the Clinical Lymphoma Program at NYU Langonne’s Perlmutter Cancer Center, commented: “Where you live and what insurance you have should not affect the length of time you survive multiple myeloma, though, unfortunately, it seems from this new study that they do. As a society we should strive to ensure that every patient, no matter their location or socioeconomic status, receives equal access to high-quality cancer care.”
Diefenbach added: “Over the last 5 years, there has been an increase in higher costs and copays. This creates a major challenge in access to medication. Patients are forced to make the challenging decision on whether to take their medication every day or horde pills to take it less frequently.”
Mark L. Fuerst is a contributing writer.