Supportive Care for Older Adults With Myeloma: Underuse of Guideline Recommendations?
Posted: Thursday, October 17, 2019
Some older adults with multiple myeloma in the United States may be receiving suboptimal levels of supportive care, putting them at a disadvantage in terms of bone protection and infection prevention, according to a study by Smith Giri, MBBS, MHS, of the Yale School of Medicine, and colleagues. Published in the journal Cancer, these findings imply that, as with multiple myeloma treatment, racial and socioeconomic disparities affect supportive care guideline adherence and could stand to be improved.
In this population-based cohort study, data from 1,996 patients with multiple myeloma, aged 66 years and older, from the Surveillance, Epidemiology, and End Results–Medicare database, were included for analysis. The postdiagnostic interventions of interest were the use of bone-modifying drugs (intravenous bisphosphonates pamidronate or zoledronic acid), flu vaccination, and prophylactic antivirals with proteasome inhibitors.
A total of 64%, 52%, and 49% of patients received bone-modifying drugs, flu vaccination, and prophylactic antivirals, respectively. Of note, patient and facility characteristics seemed to affect the odds of guideline adherence. For instance, black patients of non-Hispanic origin were less likely to receive bone-modifying drugs than white patients (odds ratio = 0.63). Non-Hispanic black patients, as well as those with dual Medicaid enrollment, were less likely to be vaccinated during flu season (odds ratio = 0.76). Finally, treatment in a community-based setting was associated with lower odds of antiviral prophylaxis than treatment in another setting (odds ratio = 0.58).
“There is abundant literature demonstrating significant racial disparities in the outcomes of patients with [multiple myeloma], with non-Hispanic blacks experiencing the worst overall survival…. Improving access to therapeutic and supportive care modalities for African Americans may help to mitigate the racial disparities in [multiple myeloma] outcomes,” the authors concluded.
Disclosure: The study authors’ disclosure information can be found at onlinelibrary.wiley.com.