A Comparative Study of Disparities in Myeloma Treatment Access | Matthew Leblanc, PHD, RN | IMS 2023

Hi, my name is Dr. Matthew LeBlanc. I'm an assistant professor at the University of North Carolina at Chapel Hill School of Nursing. And I'm here to talk about some work that I presented at the IMS 2023 conference. So I presented a poster that compared treatment access for Black older adults with multiple myeloma and white older adults with multiple myeloma. And this was a study that used a SEER Medicare data, which is somewhat national cancer registry data linked with Medicare claims. And so it included only patients over the age of 65. And what we were looking for was to see if there were differences in myeloma treatment access between Black and white patients. And in particular, we looked at whether patients were getting treated for their myeloma within 12 months of their diagnosis, and whether they were seeing a myeloma specialist at a National Cancer Institute designated comprehensive cancer center within 12 months of their diagnosis. And one of the things that motivated this work was a social theory called fundamental cause theory that proposes, among other things, that inequities that we see in health care and treatment and outcomes are fundamentally caused by social inequality. And they also propose that the more we know about treating a disease, managing a disease, or preventing a disease, the more likely it is that we'll see disparities between people in society that have connections and wealth and social standing, and the people that might not have those things. And so myeloma is an incredible test case for looking at these issues, because we've seen so much innovation in the past 20 years. And as we've seen at this conference, it seems like the innovation is actually speeding up. And as the treatments are becoming more effective and also more expensive and complicated, we need to be really careful about who might not be able to benefit from those advances. And so I looked at these treatment excess outcomes over time to see if they existed and if they were getting bigger or smaller in time. And what I found was that across time, there's a significant gap between black patients and white patients, the percentage that get treatment within one year. And the difference in 2007 to 2010 was about 6%. And it grew to about 9% in the most recent time period we had in the data. And then the difference in access to myeloma specialty care at an NCI Comprehensive Cancer Center grew from about 5% in 2007 to 2010 to about 13% in the most recent time. And while access for both black and white patients is getting better over time, it's getting better more slowly for black patients than it is for white patients. And it's something to be that as a community, the myeloma clinicians and researchers, we need to be really cognizant of what's happening. So that hopefully we can figure out ways to improve these disparities. And I really want to applaud Health Tree for the work that they're doing. I think it's been a tremendous help of educating patients about what they should expect with their diagnosis, what kind of treatments are current and most effective. And what we really need to do is figure out how to identify patients that need this information and make sure that everyone that needs it gets the information. And I think that's the work that we're going to have to do going forward to make sure that these disparities don't get bigger in time and in fact shrink.