BETA what disparities exists in access to myeloma care and novel treatments?

So, one thing that has been looked at through different databases is that people, African Americans, Hispanics, are less likely to receive triplet therapy, you know, the mainstay of induction therapy for myeloma than other ethnic groups, that they're less likely and there's a longer time, longer delay in getting those triplet therapies. We know that there's longer times of diagnosis. It takes longer for an African American myeloma patient to get diagnosed than a Caucasian patient to get diagnosed. Also, it takes longer for rural patients to get diagnosed than patients that live near academic centers. And so, one disparity is just built around the diagnosis and the treatment of myeloma. African Americans, Hispanics are less likely to get stem cell transplants. We know stem cell transplant is super important for myeloma care to extend the progression-free survival, but they're less likely. And in fact, the number of African Americans engaging in stem cell transplant has actually over those past several years, instead of rising, it has for other ethnic groups. More recent studies have shown that the underutilization of maintenance therapy, that Black patients are less likely to have maintenance therapy than patients of other ethnicities, and bisphosphonates, that the bone strengtheners that are just crucial for patients to have in order to help with pain or to strengthen the bones, less likely in Black patients than in White patients. And so, those are just some of the care disparities. Induction therapy, stem cell transplant, maintenance therapy, and the use of the bone strengtheners. I wanted to talk a little bit about disparities, which is a topic that I care a huge amount about, because I work in inner-city Chicago. Right now, we know that African Americans have about a two to three times higher chance of developing myeloma as opposed to Caucasians. The problem is we're really failing this community in terms of getting access to therapy. So we know that African Americans have a lower chance of getting proteasome inhibitor induction, they have a lower chance of accessing transplant, and even supportive care. Drugs like Zomato, bisphosphonates are used in lower amounts compared to Caucasians. So we're failing this entire segment of our myeloma community. We also know that many of those patients don't have access to clinical trials. When we look at diversity within trials, there's a very low number of African American patients that actually have access to those studies. And that means that all of these novel therapies that we know have been working, even before approval for the last few years, have just been underutilized in this segment of the community. Hi, my name is Matthew LeBlanc. I'm a PhD and a nurse and a postdoctoral research fellow at the University of North Carolina, looking at, among other things, treatment disparities in multiple myeloma patients. This is quite an interesting and important topic in myeloma where incidence and mortality among African Americans, at least in the United States, is twice as high as other racial and ethnic groups. Also there have been some sort of surprising and a little bit counterintuitive patterns of survival. So historically, non-Hispanic Black patients have had superior survival to non-Hispanic White patients, which is quite unique among cancers and other diseases. And the reasons for this haven't been completely answered, but there is some thought that there are biological differences in the multiple myeloma that African Americans tend to get that confers favorable survival. As treatments in myeloma have improved and as so many new treatments have come on the market, especially since 2000, overall survival for myeloma patients has improved dramatically. But when we look at improvement survival by race, most of the survival gains have been accrued to non-Hispanic White patients. And survival gains in non-Hispanic Black patients have been very moderate and often non-significant. And so in my mind, there are two possible explanations for the more moderate survival gains among Black patients. One of them is that the treatments that we give to multiple myeloma patients are less effective in treating the multiple myeloma that tends to appear in African American populations. I think we have evidence that this is not necessarily the case, but it's definitely worth looking to further because of the low accrual of minority patients in clinical trials. So we don't actually have a lot of data on the comparative effectiveness of our myeloma treatments in these groups. I think what is more likely the case is that the treatments that non-Hispanic Black patients, African American patients get might not be the same as treatments that's received by non-Hispanic White patients. And so some of my work is looking at sort of teasing out some of the differences in frontline treatment in myeloma patients between non-Hispanic Black and non-Hispanic White patients and looking at the trends over time. So there's a very interesting theory called the fundamental cause theory that sort of proposes that as innovations arise in healthcare, disparities increase. And so it's sort of to break it down kind of in a nutshell, if there are no good treatments, outcomes for all groups are uniformly not great. But once good treatments come on the market, which is the case in multiple myeloma, since the year 2000, there have been 26, 27 FDA approvals and there's been new classes of drugs. The treatment has really improved. It's more effective. It's also more complicated. It's also more expensive. And in that environment, you would expect that the patients that have wealth, connections, power, prestige to be able to access the better treatments more frequently than patients that are more marginalized. And so in my work that's ongoing, I'm expecting to find that over time, that disparities between the treatments that Black patients and White patients get will actually increase as the treatment for myeloma has improved. I think this is an important thing for us to document. And future steps would be to better understand the mechanisms by which these treatment disparities arise and then to develop interventions to hopefully counteract the disparities that exist and make sure that all of our myeloma patients get the best treatment possible. If you go in and the first thing you tell the patient, hey, you have this disease, I have this trial, do you want to go on the trial? No? Okay, go somewhere else. Unfortunately, some institutions do that. If you don't go on a trial, I'm not going to follow you. And I think that's a wrong message to send for any patient and in particular African-Americans. You have to remember that when we look at disparities in our center, we are looking at patients that are referred for transplant. So when we transplant our African-American patients, they have the same outcome as Caucasians, as I said, if not better. But we have noted that there is delay in referrals. So the median time to referral for a Caucasian is about six months or less.