Socioeconomic Factors and Survival of Multiple Myeloma Patients

SIMPLE SUMMARY: Multiple Myeloma is the third most common hematologic malignancy. Outcomes have improved significantly, as the result of the introduction of novel agents as well as higher utilization of autologous Hematopoietic Cell Transplant. These complex treatment regimens are quite expensive and their full applicability in the real world remains largely unknown. Several studies have shown that survival in patients with other types of cancer is influenced by their insurance, demographic factors, as well as socioeconomic status. Here we intend to examine the interplay of insurance status and other potential socioeconomic factors driving survival disparity for Multiple Myeloma patients. We used the National Cancer Database (NCDB) to assess the potential influence of these factors in this population. ABSTRACT: Background: Outcome of Multiple Myeloma (MM) patients has improved as the result of the introduction of novel medications and use of autologous hematopoietic cell transplantation. However, this improvement comes at the expense of increased financial burden. It is largely unknown if socioeconomic factors influence MM survival. Methods: We used the National Cancer Database, a database that houses data on 70% of cancer patients in the US, to evaluate the effect of socioeconomic factors on the survival of 117,926 MM patients diagnosed between 2005 and 2014. Results: Patients aged ≥65 years who were privately insured lived longer than patients with Medicare (42 months vs. 31 months, respectively, p < 0.0001). Treatment in academic institutions led to better survival (HR: 1.49, 95% CI: 1.39, 1.59). Younger age, fewer comorbidities, treatment in academic centers, and living in a higher median income area were significantly associated with improved survival. After adjusting for confounders, survival of Medicare patients was similar to those with private insurance. However, the hazard of death remained higher for patients with Medicaid (HR: 1.59, 95% CI: 1.36, 1.87) or without insurance (HR: 1.62, 95% CI: 1.32, 1.99), compared to privately insured patients. Conclusion: Economic factors and treatment facility type play an important role in the survival of MM patients.