Overview of Multiple Myeloma and Health Equity

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EP: 1.Overview of Multiple Myeloma and Health Equity

EP: 2.Biological Determinants of Health in Multiple Myeloma

EP: 3.Societal Determinants of Health in Multiple Myeloma

EP: 4.Multiple Myeloma: Disparities in Time to Diagnosis

EP: 5.Multiple Myeloma: Disparities in Access to Specialized Care

EP: 6.Multiple Myeloma: Disparities in Access to Transplantation and Novel Therapy

EP: 7.Overcoming Barriers to Early Diagnosis in Multiple Myeloma

EP: 8.Improving Access to Specialty Care in Multiple Myeloma

EP: 9.Improving Access to Clinical Trials in Multiple Myeloma

EP: 10.Addressing Healthcare Provider Bias in Multiple Myeloma Management

EP: 11.Disparities in Multiple Myeloma Care: The Path Toward Health Equity

Transcript:

Joseph Mikhael, MD: Hello everyone and welcome to this ONCLive® Peer Exchange entitled Addressing Disparities in Multiple Myeloma Care. My name is Dr Joseph Mikhael. I am a professor at the Translational Genomics Research Institute which is part of the City of Hope Cancer Center and I'm the chief medical officer of the International Myeloma Foundation. It's a particular joy for me today to have not only colleagues but friends join me who are genuine experts in the field of multiple myeloma but not only experts in the field of myeloma but indeed experts in health disparities. I know each of these individuals and their deep commitment to this issue and I'm absolutely delighted that they can join me today. I'm going to ask each of you to just quickly introduce yourselves. Why don't we start with you, Dr Buck?

Tondre Buck, MD: Sure. I’m Dr Tondre Buck, I'm a hematology physician at Gibbs Cancer and Research Institute in Spartanburg, South Carolina which is a community practice but I'm able to focus on hematology with a primary interest in multiple myeloma, thank you guys for having me.

Joseph Mikhael, MD: Oh, it's great to have you here and my good friend and sister, Doctor Irene Ghobrial.

Irene Ghobrial, MD: Absolutely. Hi everyone. My name is Irene Ghobrial. I'm from Dana Faber Cancer Institute in Boston [Massachusetts].

Joseph Mikhael, MD: Wonderful. And, Dr Ailawadhi, Sikander, why don't you introduce yourself?

Sikander Ailawadhi, MD: Thanks Joe, hello everyone I'm Sikander Ailawadhi I'm from Mayo Clinic in Jacksonville Florida.

Joseph Mikhael, MD: Last but surely not least, Dr Craig Cole.

Craig Cole, MD: I'm Craig Cole and I'm at Michigan State University College of Human Medicine and the Karmanos Cancer Institute in Lansing, Michigan.

Joseph Mikhael, MD: Wonderful, welcome each of you, we look forward to your thoughts. The plan over this next hour is to have a discussion. I'm going to take a few minutes to give a brief introduction and then we're going to go through 3 different modules as it were, and the first module is we're going to think together about both the biological and the societal determinants of health of this disease. We're going to hear specifically from Drs Ghobrial and Cole in this area as they've done so much work in this area and are known for it. Module 2, we're going to spend some time thinking about the disparities that we see in multiple myeloma care and trying to understand what the evidence for it is. If you will, diagnosing the problem, helping us understand the scope of this problem. It's interesting if you look at the literature within this field, about 90% of it focuses on the diagnosis bit as it were diagnosing the problem that we have in health disparities and very little addresses our third module and the final module and perhaps the most important, which is addressing these disparities and each of us work in this area. We'll spend some time thinking about not just what is the scope of the problem, what's the basis of the problem, what's the scope of the problem but are there solutions to the problem and none of us suggest that we have the immediate answer to all of this issue. There are very pragmatic things that we can do at multiple levels from the governmental to the regulatory, indeed to within our own clinical practice, as an industry, so many ways that this can be addressed, and we hope that many of those topics will come out tonight as we discuss them together. Just by way of introduction, this is a topic that is not only important because in some respects we know that the whole of the country if not the world is starting to recognize the greater challenges with health equity and in many respects, I support that. If this is a wave, I just want it to be a wave that continues indefinitely to have people recognize the importance of this but this is something particularly important in multiple myeloma. We see tremendous health disparities in cancer but as we're going to go through the data, we're going to come to see we can argue that perhaps the greatest disparity is that in multiple myeloma. I'm not going to steal fire from all the facts that we're going to share later but 3 simple facts; we know that myeloma is twice as common in the African American population which is a particularly important biological phenomenon that we're going to discuss in a moment however we know very sadly that myeloma diagnosis is made significantly later in the African American population. We're going to talk about that. Even just today I saw a patient in clinic, and she was explaining to me that she had this rib pain and a rib fracture and it took 18 months before someone pieced together that her 3 separate rib fractures were indeed connected to multiple myeloma. Thirdly and perhaps most strikingly that leads us to want to make such a difference in this area is to recognize that although we've seen this great survival improvement in myeloma, that right now the average survival in myeloma patients is half that in African Americans when compared to White Americans. This tremendous disparity and that is arguably the greatest disparity. We see disparities in prostate cancer, lung cancer and other areas, I'm not minimizing those but arguably the greatest disparity in overall survival is seen in multiple myeloma. The facts are evident. The importance of it is evident and hopefully as you listen to this program today in whatever capacity you come whether you're a provider, whether you may be a patient or a caregiver or a care partner and somehow involved in the care of patients with multiple myeloma, that the facts do more than just move your mind but indeed move your heart and your hands for us to demonstrate a commitment to do something. I do believe that this is something we all have to be involved with and we all have to help overcome and there is hope and there is clear evidence that we can make a difference if a significant commitment is made. I'm not going to say much more from the basics apart from saying that when we look at this disparity as we're going to discuss in more detail, we have to recognize that it is based on multiple phenomenons. This isn't a single problem that requires a single answer. We're going to be discussing issues of biology, issues of systemic racism, of societal determinants of health, of access. Sometimes I call it access to the four Ts'; triplets, transplants, trials and now CAR-T and we've seen significant disparity in access to those four Ts and indeed to so much of the health care that's necessary to be able to overcome this health equity gap.

Transcript edited for clarity.