Review Details Racial/Ethnic Disparities in MM, Offers Guidance for Improvement

Multiple myeloma (MM) is the second most common hematologic malignancy in the world. However, significant racial disparities exist when it comes to utilization of novel therapies and clinical trial participation.

Researchers aimed to address these disparities, along with others, in a new review that outlines culturally responsive care delivery recommendations for the medical community. They published their findings in Clinical Lymphoma, Myeloma & Leukemia.

In the United States, the incidence of MM is at least 2 times higher among Black individuals compared with their White counterparts, while Hispanic/Latinx individuals are among the youngest patients to have the disease diagnosed, study authors wrote.

Several factors preclude patients of color from benefiting from the latest treatments for the condition. These include barriers to care access, socioeconomic status, and medical mistrust.

“Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes,” the researchers said.

Additional social determinants of health like housing, employment, education, and health literacy also play a role.

In the current review, the authors focused on racial/ethnic factors and structural barriers present regarding variations in MM epidemiology and management. The review spotlights 3 patient populations: Black/African American, Hispanic/Latinx, and American Indian/Alaska Native.

Research has shown Black patients with MM have a significantly higher risk of emergency department visits than their White counterparts. In addition, although relative survival rates have increased for White patients over the years, those reported among Black patients have been smaller and not significant. This is likely due to inequity in access to care, the authors said.

“Notably, with equitable access to care, Blacks/African Americans and Hispanics/Latinxs have similar or better survival outcomes than Whites.”

Additional studies have found the prevalence of monoclonal gammopathy of undetermined significance, an important precursor to MM, is 4 times greater in Black patients than White patients. Black and Hispanic patients also have higher rates of negative prognostic markers for MM than other races, including anemia, renal dysfunction, and lactate dehydrogenase level.

The study authors note Black patients may be more likely to experience mistrust of the health care system, thanks to historical mistreatment and present-day experiences of discrimination.

Hispanic/Latinx patients are more likely to be uninsured than their Black and White counterparts. One survey cited by researchers found 45% of Hispanic/Latinx adults in the United States are immigrants.

“Because a person's right to work legally is tied to their immigration status, undocumented immigrants have limited or no access to private insurance offered by employers; they are also not eligible for coverage offered through federal and state health insurance schemes,” the authors said. Even documented immigrants may face hurdles to insurance coverage such as language and literacy barriers.

American Indian/Alaska Native individuals have lower socioeconomic status measures than their White counterparts. More than half of these individuals also rely on the Indian Health Service. Both funding constraints and insufficient clinician availability can affect the quality of care provided at these sites.

Overall, “Systemic and structural racism are deeply embedded in systems, laws, policies, and practices and contribute to widespread health inequities among people of color,” the authors explained.

By practicing cultural humility, they stressed providers can help mitigate these disparities. Researchers defined cultural humility as emphasizing “the need to question one's own assumptions, beliefs, and biases; respect differences; learn from individuals; build partnerships; and reduce power differentials.”

To incorporate this into practices, they recommend health care professionals take the following steps:

• Establish trust
• Respect cultural diversity
• Undergo cross-cultural training
• Counsel patients on appropriate available clinical trial options
• Connect patients to community resources

However, “studies showing the impact of implementing such recommendations in health care practice are currently not available for MM and are an opportunity for future research.”

Moreover, the concepts of culturally responsive care and cultural humility are poorly understood within the oncology community in general, suggesting more need to be done.

“In addition to achieving competence in understanding the distinct characteristics of disease presentation and risk factors associated with race/ethnicity, acknowledgment of cultural nuances and history or past harm perpetrated by the health care system to historically marginalized populations will help [health care professionals] understand what is valuable to the individual patient,” the authors concluded.

Reference

Blue B, Pierre A, Mikhael J. Culturally responsive care delivery in oncology: the example of multiple myeloma. Clin Lymphoma Myeloma Leuk. Published online May 6, 2023. doi:10.1016/j.clml.2023.05.005