Multimorbidity, Insurance Status May Affect Survival Rates of Patients With Multiple Myeloma

Multimorbidity, insurance status, and income may affect survival rates of patients with multiple myeloma (MM), according to 2 abstracts presented at the 2019 American Society of Clinical Oncology Annual Meeting, held May 31-June 4, 2019, in Chicago, Illinois.

In the first abstract, researchers examined how specific comorbidities affected rates of survival in patients with MM.

“The majority of older adults carry 2 or more chronic conditions,” researchers said. “Although comorbidity in MM has often been described with comorbidity counts, the impact of multimorbidity clusters has yet to be investigated.”

Data were gathered from the Veterans Affairs Healthcare System. A total of 7815 patients at least 60 years of age who were diagnosed with and treated for MM were identified. Researchers searched for 53 CMS-defined chronic and disabling conditions from claims filed by patients 3 years prior to their MM diagnosis. Latent class analysis was performed to identify patterns of multimorbidity that coexisted with MM at the time of diagnosis.

Researchers then assessed whether multimorbidity patterns were associated with survival in 5992 non-transplanted patients who were initially treated with doublet or triplet chemotherapy regimens. Data were adjusted for stage of MM, sociodemographic factors, and prognostic lab values. The mean follow-up time was 3.1 years.

Researchers identified 6 multimorbidity clusters at the time of MM diagnosis. Of the cohort,

• 2011 patients, or 25.7%, had cardiovascular disease
• 1820 patients, or 23.3%, had diabetes and complications
• 1302 patients, or 16.7%, had minimal disease
• 992 patients, or 12.7%, had multisystem impairment
• 931 patients, or 11.9%, had psychiatric and substance use disorders
• 759 patients, or 9.7%, had chronic lung disease

Researchers determined that specific comorbidities had varying effects on survival rates of patients with MM:

• patients with minimal disease had the highest rates of survival, with a median survival of 4.5 years and a 47.5% chance of surviving 5 years
• patients with multisystem impairment had the lowest survival rates, with a median survival of 2.4 years and a 24.3% chance of surviving 5 years
• after adjusting for covariates, patients with clusters of chronic lung disease, psychiatric and substance use, and multisystem impairment had higher likelihood of early death than patients with minimal disease

“We found higher-impact and lower-impact multimorbidity clusters among older veterans with newly-diagnosed MM treated with chemotherapy. Unique combinations of chronic diseases may interact with MM itself to drive differences in mortality,” researchers concluded.

Insurance Status and Survival. In the second abstract, researchers investigated whether survival rates of patients with MM were affected by their income or insurance status.

“MM is often treated with oral antineoplastic medications (OAM). OAM prices have been rapidly escalating and there are well-described issues with affordability,” researchers said. “We therefore hypothesized that insurance status influences MM patients survival and interrogated the National Cancer Database (NCDB) to test this hypothesis.”

Researchers used the NCDB to gather and analyze data from 117,926 patients with MM who were diagnosed between 2005 and 2014. The study’s primary outcome was overall survival (OS) which was analyzed using the Kaplan-Meier method and a Cox model.

Participants had a median age of 67 years at diagnosis, 55% were males and 57% of lived in locations where the median income was less than $46,000 per year. Data on patients’ individual incomes of patients were unavailable. Regarding insurance status,

• 52% of patients were insured by Medicare
• 35% of patients had private insurance
• 5% of patients were insured by Medicaid
• 3% of patients were uninsured

The median age of patients was:

• 74 for those who had Medicare
• 58 for those who had Medicaid
• 57 for those who had private insurance
• 57 for those who were uninsured

A total of 40% of patients were treated in academic institutions. The median follow-up time was 30 months. Univariate analysis showed that patients with primary MM, lower Charlson Comorbidity Index scores, higher median regional incomes, private insurance, those who were treated at academic institutions had better OS.

When analysis was restricted to patients 65 years of age or older, researchers found that patients who had private insurance had longer OS than those insured by Medicare.

Researchers concluded that insurance type and regional income were associated with MM survival rates. They suggested the cost of OAM may affect OS and recommended that the relationship should be investigated further.

Reference

1. Fillmore N, DuMontier C, Cheng D, et al. Multimorbidity patterns and their association with survival in a large national cohort of older veterans with multiple myeloma. Presented at: American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2019; Chicago, Illinois. Abstract 8033.

2. Chamoun K, De Lima MJG, Caimi PF, et al. Insurance status and survival of multiple myeloma (MM) patients. Presented at: American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2019; Chicago, Illinois. Abstract LBA107.