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Racial disparities in treatment use for multiple myeloma
Author(s) -
Fiala Mark A.,
Wildes Tanya M.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30526
Subject(s) - medicine , multiple myeloma , bortezomib , health equity , hazard ratio , epidemiology , transplantation , cancer , public health , intensive care medicine , oncology , gerontology , pathology , confidence interval
BACKGROUND Recent treatment advances have greatly improved the prognosis of patients with multiple myeloma. However, some of these newer, more effective treatments are intensive and expensive and their use remains low, particularly among black patients. METHODS In the current study, the authors reviewed the use patterns of stem cell transplantation and bortezomib using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database. RESULTS After controlling for overall health and potential access barriers, black patients were found to be 37% ( P <.0001) less likely to undergo stem cell transplantation, and 21% ( P <.0001) less likely to be treated with bortezomib. Moreover, the authors found that the underuse of these treatments was associated with a 12% increase in the hazard ratio for death among black patients ( P = 0.0007). CONCLUSIONS Eliminating health disparities, a current focus of US public policy, is highly complex, as illustrated by the results of the current study. In patients with multiple myeloma, treatment disparities are not completely explained by potential access barriers. Additional factors, such as structural barriers in the health care system and individual decision making among black and white patients, must be explored to fully explain the disparity. Cancer 2017;123:1590–1596. © 2017 American Cancer Society .