Does Race Impact Myeloma Care? An Expert Explains Study From ASCO

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Rebecca Seago-Coyle:

Caring for every patient, learning from every patient, what does that mean to you, and how do you take that information back to your clinic?   

Dr. Ailawadhi:

I think, Rebecca, that's an excellent question.  So this theme of caring for every patient, learning from every patient, I think we talk about clinical trial studies, we talk about education, empowering the patient, but if you take a step back as a clinician, as a provider, every single patient that I see in the clinic, it's important to know that they can be different. They can be heterogeneous.  The same diagnosis in different patients can behave differently, so I think that ASCO's focus of focusing on every single patient as an individual, learning from that patient, and then trying to improve our practice so that the next time we go out to take care of the following patient we can learn from that experience and also apply it to that patient to get the best outcomes.   

Rebecca Seago-Coyle:

Great.  Thank you so much for sharing that.  And you spoke on racial disparities here at ASCO.  Can you talk a little bit more about some of the specifics that came from that?  

Dr. Ailawadhi:

Sure.  Sure.  So I think in the same theme of learning from every patient and caring for every patient, the concept that multiple myeloma, the focus that I have, there was this session that was dedicated to the different shades of disparity in myeloma care. So we touched upon global disparities across the world.  We touched upon rural, urban disparities, and we also talked about racial, ethnic disparities.  

So our population demographic in the US is changing very rapidly.  We are no longer just a clear demarcation of saying whites versus whites. Now we have whites, black, Hispanics, Asians, multiple other subtypes within each group, and quite frankly a lot of admixture, a lot of over and above that.  

There is a lot of data in multiple myeloma literature showing that unfortunately not patients with all races and ethnicities are getting the same benefit of treatments.  In fact, even the outcomes are different.  The survival is different.  So that gives us the opportunity to try and look at why are these differences?  Are there issues with how we provide care?  Are there cultural, social barriers?  Economic, education, income, etcetera, insurance?  

So in that particular session we tried to bring together all the data that can exists about this topic so far and to, first of all, try and understand what are the differences, how could the disease be different.  We know that in African-Americans they will present with less fractures from myeloma, but they will present with more kidney dysfunction.  So if as a physician I know about that, I'm a little bit attuned to that, I can address those needs better.  We know that African-Americans will have generally not as high risk of a disease as whites.  

And then the biggest kind of elephant in the room is whether access to care is similar or not.  Now, there are many, many studies that are showing that access to care is unfortunately not similar.  Patients in rural America, patients belonging to racial ethnic minorities don't get the appropriate treatment in a timely fashion. We shared data that Hispanics, for example, it takes the longest time to get the Hispanics to one of the cornerstone drugs for myeloma care, a median of 102 days, when the idea is that earlier treatment is better.  Transplant is used much lesser in African-Americans and Hispanics, and unfortunately it seems that in the recent past those numbers are not even increasing.  

Rebecca Seago-Coyle:

What about diagnosis? Are you seeing like the Hispanic community getting that early diagnosis?  

Dr. Ailawadhi:

Excellent question. While we don't have that clear-cut of data existing in myeloma yet, but from a lot of cancers it has been reported, even at some of data at this ASCO, that patients who are minorities, Hispanics, they may actually get diagnosed later.  There was one piece of information that we shared in our session about disparities in myeloma care that Hispanics tend to get referred to an oncologist—or Hispanics are more likely to be a stage III disease as compared to whites who may be referred at an earlier stage.  

Now, that could of course again depend on sociocultural economic barriers, but the bottom line is that there is a difference, and that's not good.  And if that difference actually is affecting the patient outcomes, then it becomes an obligation for us as a society, as healthcare providers, as a community, as politics, as a country, to try and overcome those disparities so at least we can give the basic minimum appropriate care to every single patient.  

Rebecca Seago-Coyle:

Okay.  So now could you tell us a few key takeaways that our viewers would be interested in hearing about?  

Dr. Ailawadhi:

Sure.  So I don't want it all to sound that there are too many problems. There are problems, and I'm so glad that there is a lot of will and a lot of effort to try and understand those problems.  So what we found—on a better note, what we found in our analyses and it's also published we shared with the ASCO community in our session yesterday that when patients get the right and evidence-based treatment, whether it is through clinical trials, whether it is transplant, then the outcomes of minorities and white comes out to be the same.  So as long as we can get the right treatment to the right patient at the right time the outcomes can be similar, and the minorities can hopefully even have better outcomes.  

Rebecca Seago-Coyle:

Great.  Thank you so much for sharing.  

Dr. Ailawadhi:

Absolutely.  

Rebecca Seago-Coyle:

And thanks to our listeners. Remember, knowledge can be the best medicine.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.