Hello. My name is Amy Pierre. I'm a senior clinical director at Flatiron Health and a nurse practitioner in the Myeloma Lymphoma division at Memorial Sloan Kettering. And I'm pleased to talk to you today about my abstracts that looked at structural racism and social determinants of health factors and fish testing. So why is this so important in multiple myeloma? Fish testing, also known as fluorescence insitu hybridization, is a test that we do at diagnosis and at relapse as well on the bone marrow to sort of understand risk stratification for the patient.
Are they high risk, are they have standard risk multiple myeloma. And also we can see if there's different mutations or translocations that may be eligible for sort of biomarker driven therapy. So we know that there's various factors that can play a role on access to care and outcomes. So we wanted to see if factors such as structural racism manifesting as residential segregation and other social determinants of health factors such as urbanicity, living in a medically underserved area, living in an area that has residents with limited English proficiency, living in an area that has low vehicle ownership.
We looked at all of these different factors to see if it actually influenced the ability of a patient to have a fish test. So in our flat iron network, we have access to about 250 different cancer clinics, which translates to about 800 sites of care. So it is a well diverse, patient population that we're looking at in the United States.
And we're looking to see if they had a fish test at diagnosis or even any time during their disease trajectory. We looked at about a little over 13,000 patients who had been diagnosed with multiple myeloma prior to January 2024, because we wanted to have some long term follow up. We did find some associations that patients who lived in neighborhoods that had a high amount of patients with limited English proficiency were the least likely to get a fish test.
And we also found a gradient relationship in terms of vehicle ownership. So patients living in areas that had a high percentage of lack of vehicle ownership were less likely to get a fish test. And we saw that gradient become more, that association become more and more pronounced as the quartiles change in terms of vehicle ownership. So this tells us that there are social determinants of health factors at play and access to standard of care testing like fish testing.
And this sort of brings us to the attention that we need to have some sort of policies and initiatives in place to address language barriers and transportation barriers for patients to get testing like this. And it also has implications for biomarker driven clinical trial participation. Right. If you don't have this test, we don't know what kind of biomarkers that you might have that would make you eligible for a clinical trial.
So it's just designed to really help patients understand that there are barriers in place and that we need to be aware of it. Also, as clinicians assist our patients with the resources that they need.
Our data, we don't collect the bone marrow biopsy unless we're looking for the actual FISH test.
So that makes me think that maybe they didn't have a bone marrow biopsy or that documentation is missing, or they did. And the the fish test wasn't done. But it is a little bit strange to actually have the tissue and not take the step forward to do the testing.
HealthTree • December 18, 2024