Hispanic Population Has Worse Treatment Access/Outcomes in Multiple Myeloma

Hispanic patients with multiple myeloma appear to experience several disparities including access to effective treatments and overall outcomes compared with non-Hispanic White patients and other ethnic groups, according to findings from a systematic review published in Clinical Hematology International.

Samer Al Hadidi, MD, MS, FACP, assistant professor of medicine in the Winthrop P. Rockefeller Cancer Institute, University of Arkansas

Of 22 studies that were evaluated, 59% reported worse outcomes for Hispanic patients with multiple myeloma compared with those of other ethnic groups. Clinical trials enrolled Hispanic patients at a lower rate than other groups; at the same time, multiple myeloma occurred more frequently in Hispanic patients.

The median age at presentation was 5 years younger for Hispanic patients compared with non-Hispanic White patients; despite these earlier diagnoses, Hispanic patients were found to have a greater risk of death than other groups. Hispanic patients also were more likely to live in zip codes with a lower socioeconomic status and education levels, which investigators suggested could partly explain this higher risk.

“We emphasize the need for immediate attention and solutions to address these disparities and promote equitable access to care for Hispanic patients with multiple myeloma,” study author Samer Al Hadidi, MD, MS, FACP, said in a written comment to CancerNetwork®. “The review also highlights the importance of diversifying the medical workforce and providing culturally sensitive care.”

Al Hadidi is an assistant professor of medicine in the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas.

To derive these findings, investigators combed several databases, including EMBASE, MEDLINE/PubMed, CINAHL, Scopus, and Web of Science for English-language literature during December 2021. The searches returned a total of 868 records, of which 212 were related to the same patients. A further 595 did not fulfill the inclusion criteria, and 39 of the remaining 61 were excluded for the same reason.

Publication dates varied; the most common was 2021, during which 32% of the 22 assessed studies were published. The studies were drawn from 16 different journals with 179 individual contributing authors.

Additional findings included a lower rate of autologous stem cell transplantation among Hispanic patients, and a higher rate of in-hospital mortality vs other groups. Hispanic patients also received less maintenance therapy and fewer supportive therapies like bisphosphonates. A longer time between diagnosis and receipt of novel therapy was more prevalent among Hispanic patients than non-Hispanic White patients. Improvements in survival due to newer therapy options were also the least pronounced among Hispanic Americans.

There was no difference in adverse risk cytogenetics between Hispanic patients and non-Hispanic White patients and non-Hispanic Black patients.

“Hispanic Americans were found to receive less multiple myeloma maintenance therapy and supportive treatments,” Al Hadidi said. “They also had delayed initiation of novel therapies and lower rates of autologous stem cell transplantation. …We [believe] various factors contribute to these disparities, including limited access to care, lower utilization of effective treatments, financial and structural barriers, and underrepresentation of Hispanic Americans in clinical trials.”

The investigators did not conduct quality assessments of the 22 studies, which they described as a potential limitation of this review. Moreover, the studies may have used inconsistent definitions of “Hispanic,” and some divided this group into “Hispanic Whites” and “Hispanic Blacks,” possibly confounding these results.

Reference

Anampa-Guzmán A, Alam ST, Abuali I, Al Hadidi S. Health disparities experienced by Hispanic Americans with multiple myeloma: a systematic review. Clin Hematol Int. 2023;5(1):29-37. doi:10.1007/s44228-022-00026-2