2019 ASCO Annual Meeting!
Session: Evidence, Care, Impact: Making Inroads Against Cancer Disparities
Type: Clinical Science Symposium
Time: Sunday June 2, 9:45 AM to 11:15 AM
Location: Hall D1
Insurance status and survival of multiple myeloma (MM) patients.
Care Delivery/Models of Care
Health Services Research, Clinical Informatics, and Quality of Care
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr LBA107)
Author(s): Kamal Chamoun, Marcos J.G. De Lima, Paolo Fabrizio Caimi, Pingfu Fu, Shufen Cao, Folashade Otegbeye, Seema Patel, Naveed Ali, Stanton L. Gerson, Kirsten M Boughan, Ravi Kumar Kyasaram, Ehsan Malek; Adult Hematologic Malignancies and Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Cleveland, OH; University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH; Department of Population and Quantitative Health Science, Case Western Reserve University, Cleveland, OH; Department of Biostats and Epidemiology, Case Western Reserve University, Cleveland, OH; Adult Malignant Hematology, Seidman Cancer Center, Cleveland, OH; Case Western Reserve University Seidman Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Hematology and Oncology, University of Cincinnati, Cincinnati, OH
Background: MM is often treated with oral antineoplastic medications (OAM). OAM prices have been rapidly escalating and there are well-described issues with affordability (Shih et al. JCO 2017). We therefore hypothesized that insurance status influences MM patients (pts) survival and interrogated the National Cancer Database (NCDB) to test this hypothesis. Methods: NCDB houses data on 70% of cancer pts in the USA. Data from 117,926 MM pts diagnosed between year 2005 and 2014 was analyzed. Primary outcome was overall survival (OS) which was analyzed using Kaplan-Meier method and Cox model. Results: Median age at diagnosis was 67 years (19-90); 55% were males. 57% of pts lived in areas where the median income was < $46k/year (individual income data was not available); Primary insurance was Medicare (52%), private insurance (35%) or Medicaid (5%), and 3% were uninsured. 40% were treated in academic institutions. Median follow up was 30 months (0-145). By univariate analysis, better OS was observed in pts with primary MM, lower Charlson Comorbidity Index (CCI), treatment in academic institutions, higher median regional income, or private insurance (p<0.0001 for all). Median age of pts on Medicare, private insurance, Medicaid, or those without insurance was 74, 57, 58, and 57 years, respectively. When restricting the analysis to pts ≥ 65 years old, pts with private insurance had longer OS compared to Medicare pts (p<0.0001). The table shows the results of MV analysis. Conclusions: Insurance type and regional income are associated with MM survival. This may be related to affordability of OAM and merits further investigation.
|Age per year increase||1.04||1.04 - 1.05||< .0001|
|Male/female||1.06||.99 - 1.14||.098|
|White/black||1.07||.98 - 1.17||.124|
|Primary/secondary MM||.95||.86 - 1.04||.242|
|CCI 0/≥3||.48||.39 - .59||< .0001|
|1/≥3||.7||.57 - .87||.002|
|2/≥3||.92||.72 - 1.16||.47|
|Academic institution/other||1.49||1.39 - 1.59||< .0001|
|Medicare/private insurance||1.09||.99 - 1.2||.073|
|Medicaid/private insurance||1.59||1.36 - 1.87||< .0001|
|Not insured/private insurance||1.62||1.32 - 1.99||< .0001|
|Other/private insurance||.95||.66 - 1.39||.802|
|Median income in area of residence < $46k/≥ $46k||1.16||1.08 - 1.25||< .0001|
* Stem cell transplant status not included (only 15.7% were reported to have received it).
3. Early case ascertainment and prospective multidisciplinary review for management of new melanoma diagnoses within an integrated healthcare system: The Kaiser Permanente Northern California experience.