Exploring gender-based decision-making differences among patients with relapsed/refractory multiple myeloma.
Authors: Arnett Mary , Castro Bórquez Karla Mariana , Hurtado Martínez Jorge Arturo , Robles Espinoza Andrea Isabel , Flores Pérez Patricia Alejandra , Cuevas Vicencio Andrea Jimena , Flores Quiroz Felipe , Jensen Rachel M. , Orlowski Robert Z. , Strain Julie , Iadeluca Laura L. , Solomon Rachel , Delwart Virginie , Chmielewski Cynthia , Ahlstrom Jennifer M. , Hydren Jay R 
Published: June 2024

e19524

Background: As therapeutic options for relapsed/refractory multiple myeloma (RRMM) expand, patients face complex treatment decisions. Despite gender-related differences observed in healthcare preferences and decision-making, such distinctions in MM patients are understudied. This study aimed to evaluate RRMM patients' gender-based preferences in treatment decision-making. Methods: HealthTree Cure Hub (PMID: 35271305) was used to administer a 30-question survey that covered 11 domains influencing decisions at the moment of treatment change This analysis explores gender difference across 3 domains: treatment, patient, and educational-related. Patients rated each aspect on a scale from 1 (not at all influential) to 5 (extremely influential) or 1 (never) to 5 (all the time). Results: This analysis included 289 patients with RRMM with an age of 66±9 yr (mean±SD), 53% were female, and 48% had professional school education. Of 244 demographics respondents, 91% identified as white. Women did not rate any factors less than men. On treatment-related factors, two were influenced by gender: first, 51% of women rated potential side effect severity as very or extremely influential vs 38% of men (F: 3.4±1.3; M: 3.2±1.1, p < 0.05), and second, supportive care requirements or needs (help for daily activities, caregiver burden) were deemed more influential among women (F: 2.5±1.4; M: 2.1±1.3, p < 0.05). Regarding patient-related factors, women rated the impact on quality-of-life higher than men (F: 3.6±1.3; M: 3.2±1.3, p < 0.05), and more women rated it as very or extremely influential than men (61% vs 49%, p = 0.018), at 1st change. Emotional state (anxiety, etc.) was rated higher by women at the first change in therapy (F: 2.6±1.4; M: 2.0±1.2 , p < 0.05); the gap widened for subsequent changes in therapy (F: 2.7±1.4; M: 1.8±1.2, p < 0.05). Physical condition (frailty) had a higher influence on women (F: 2.8±1.4; M: 2.2±1.3, p < 0.05), and more women rated frailty as very or extremely influential (37% v 21%, p = 0.03). The top two resources for MM Education were: 1) medical team recommendations (F: 89%; M: 92%, almost or every time) and 2) patient advocacy myeloma websites (F: 66%; M: 54%). Interestingly, women used patient advocacy websites more at 1st change in therapy than men (F: 3.8±1.2; M: 3.5±1.2, p < 0.05), and increased use for subsequent relapses (F: 4.2±0.9; M: 3.6±1.2, p < 0.05), while men maintained their high utilization rate. Conclusions: Both genders highly value medical efficacy. However, secondarily, women prioritize emotional state (anxiety, etc.) and practical aspects impacting quality-of-life, while men generally rated these aspects less than women. The top educational resources for both genders were their medical care team followed by patient advocacy myeloma websites. This prompts the integration of decision-making factors to formulate care strategies attuned to the individual’s unique journey.