Welcome to Health Tree University. In this course, we'll be going over disparities and multiple myeloma. In this lesson, we'll define cancer disparities, social determinants of health, dive into the disparities we're facing in multiple myeloma, and what is being done to address them. Let's start with the basics. What is a cancer disparity? Disparity essentially is a way to define a difference in terms of what you're seeing in a population. So, for example, when we talk about cancer disparities and we look at different patient populations, whether it's an ethnic population or a population from a different district, If we see a difference in terms of the outcomes for one population compared to the other, that can be a cancer disparity. If everyone is receiving the exact same care and exact same outcomes, no disparities exist. If there are differences in outcomes between groups based on race, socioeconomic status, those are disparities. If we see a difference in terms of the survival for one patient population over another, that can be a disparity. If we see a difference of economics or finances that is affecting the patient population, especially in cancer, that can also highlight some disparities and differences that we might see in the patient population. Probably some of the most important disparities is when you see that some groups are performing and doing better than other groups that can't be explained by biologic mechanisms and may be more directed towards social determinants of health that are really the ones that you worry about because those are the potentially correctable ones where you can then bring people up. Next, what are the social determinants of health? So social determinants of health are those non-medical things that can have an impact on one's health care. And so it can include socioeconomic status, it can include transportation, it can include access to quality schools, it can include access to quality health care, it can include, it also involves patients' social spaces where they live at. So one's community has a huge impact on their health. Now that we've defined some of the terms, how does socioeconomic status play a role in myeloma disparities? Myeloma care costs a lot of money. And patients that are underinsured or on Medicaid, Medicare without private insurance have more difficulty engaging in a lot of those really good myeloma therapies than other groups. Socio-economic status, that has a direct impact on quality education, also has a direct impact on your occupational status. And it can limit your ability to be able to obtain jobs that offer quality health care assurance, jobs that offer sick days or personal days so that you can get to the doctor's office, jobs that will allow you to have insurance that allows for lower co-pays, lower deductibles, things of that nature which can very well have an impact on one's ability to be able to receive the health care that they need. There was a study that looked at, again, the SEER database, which is a massive database throughout the United States, and saw that patients that have high socioeconomic status do better than patients that, middle socioeconomic status, which do better than patients that have low socioeconomic status. And because that low socioeconomic strata is a lot of patients of ethnicity built in and rural patients built in, their overall survival is lower because of really financial constraints of being in that low socioeconomic strata. What about the disparities in access to quality care? Not being able to have continuity of care or continue your care, except getting sporadic care maybe in the emergency room setting or something like that. Not being close to a health care center that will have a myeloma specialist or a provider that understands or has the resources to care for you with multiple myeloma. Myeloma care is better in the high academic centers. And so the excellence of myeloma care, that there's better survival at those places. However, some groups are less likely to engage those academic centers. There's, again, some of those distrust of clinical trials and distrust of the medical system that has been fostered for generations makes people less likely to engage some of those academic centers. But also we're talking about a lot of the socioeconomic disparities, educational disparities come from a deeply rooted system of racism that we have had to deal with for hundreds of years in this country. So when you're dealing with all of those things, it leads to lack of access, lack of diagnoses. Sometimes patients who are going in to get care, their symptoms may not be addressed in a timely manner. And sometimes they sometimes don't feel heard when they're going in with their complaints. So all of those things can lead to delay in diagnosis and a worse outcome. What disparities exist in multiple myeloma and are they always racial in nature? Multiple myeloma, like many cancers, you can sometimes see disparities in different patient populations. So when we look at patients with multiple myeloma, sometimes you might see a population in a certain, for example, rural versus urban, and you look at those two populations of patients with multiple myeloma and you see a difference in terms of outcome. That's not necessarily a racial disparity, that can sometimes be a socioeconomic disparity. And so there are different things that can highlight disparities in multiple myeloma. What are the disparities that exist in the incidence of myeloma? So incidence is a way that we measure how many patients have a certain disease. And the classic way we describe incidence is if you get 100,000 people, how many of those 100,000 people have myeloma? Or how many of those 100,000 people have breast cancer or colon cancer? And so it's a good way when you get a group of people to say, well, how often does this occur? This is actually a blood cancer that is two times more common in the African-American population. In addition to that, the precursor condition, there's something called MGUS, or monoclonal gliopathy of undetermined significance, which is also two to three times more likely to occur in African-Americans than other populations. And what we find is patients who are African-Americans are also diagnosed at a younger age. So for myeloma, it's approximately five years younger. For the MGUS, which is a precursor condition, it can be anywhere between five to 10 years younger that patients are diagnosed. And so what that means is this is a type of disease, a type of cancer that affects the African-American population more than others. What biological differences exist between ethnicities and multiple myeloma? One other thing that we see as a difference between ethnicities, and that's again more biologic, is that those myeloma defining events, so the hypercalcemia, renal insufficiency, anemia and bone disease, that three, the CRA, the hypercalcemia, renal insufficiency and anemia are more common in African patients than in Caucasian patients. Caucasian patients are more likely to present with bone disease than Black patients. When you look biologically and you look at the cytogenetics from one group of patients to another, you might see a higher risk of high risk cytogenetics in one group of patients versus another group. That can also be a disparity in and of itself. One, I think, really interesting point is that the high risk cytogenetics, very different. Several studies have shown that Caucasian patients are more likely to have those high risk cytogenetics, that deletion of the 17th chromosome, the addition of the first chromosome, the connection, the translocation of the 4 and 14th chromosome. They're more likely to have that Caucasian patient, more likely to have the high risk cytogenetics in Black patients, which is a huge difference. And Black patients are more also patients of high African ancestry, which is what the study showed, more likely to have the 11-14 translocation, which is used, you know, which is the target for the drug Vanita class than Caucasian patients. But all those things kind of make the playing field a bit unequal. Some of those are things that we can hopefully change in the future. Some of those things are hardwired. Understanding what these disparities are and their impact can help patients feel more in control of their disease. If you found this video helpful, consider giving us a like and subscribing to Health Tree University. Our mission is to educate patients and spread awareness about multiple myeloma. We'd like to thank our doctors, our sponsors, and of course our audience for making this video possible. See you next time on Health Tree University.