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Underutilization of guideline‐recommended supportive care among older adults with multiple myeloma in the United States
Author(s) -
Giri Smith,
Zhu Weiwei,
Wang Rong,
Zeidan Amer,
Podoltsev Nikolai,
Gore Steven D.,
Neparidze Natalia,
Ma Xiaomei,
Gross Cary P.,
Davidoff Amy J.,
Huntington Scott F.
Publication year - 2019
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.32428
Subject(s) - medicine , odds ratio , guideline , confidence interval , medicaid , vaccination , logistic regression , epidemiology , health care , immunology , pathology , economics , economic growth
Background With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment‐related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown. Methods This study used the Surveillance, Epidemiology, and End Results–Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008‐2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline‐recommended supportive care, which was defined as 1) bone‐modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility‐level characteristics and supportive care use. Results Among 1996 patients receiving MM‐directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non‐Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46‐0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34‐0.54) had lower odds of BMDs. Non‐Hispanic blacks (OR, 0.52; 95% CI, 0.37‐0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58‐0.99) had lower odds of influenza vaccination. Treatment in a community‐based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46‐0.72). Conclusions Substantial underutilization of guideline‐recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM.