Abstract 1936: Demographic and socioeconomic determinants to the access to multi-agent therapy in multiple myeloma: A National Cancer Database (NCDB) analysis of years 2004-2017
Authors: Saba Ludovic , Chaulagain Chakra Pani , Liang Hong , Dominguez Barbara , Fu Chieh-Lin 
Published: April 2023

Abstract
Background: Multi-agent therapy consisting of Immunomodulatory Drug (Lenalidomide), Proteasome Inhibitor (Bortezomib), and Dexamethasone revolutionized patient outcomes in Multiple Myeloma (MM). In this retrospective analysis, the NCDB database was used to evaluate the determinants that affected access to multi-agent therapy among MM patients who were treated in commission on cancer-accredited facilities across the USA.
Methods: Using the NCDB, we identified N= 171,261 patients diagnosed with MM from 2004 to 2017. Multivariate logistic regression analysis was conducted to identify the predictive factors for receiving multi-agent therapy, using significance level of p&lt0.05. Multivariable cox regression was used to determine factors affecting survival in patients receiving multi-agent therapy. Kaplan-Meier (KM) survival curves for single and multi-agents were produced. SAS version 9.4 was used to analyze the data.
Results: Five potential disparity factors were identified by multivariate logistic regression analysis: race and ethnicity, facility type, insurance status, median household income and level of education. Non-Hispanic Black patients had lower odds of receiving multi-agent therapy compared to Non-Hispanic White patients (OR=0.93, p&lt0.0001). Hispanic Black patients had higher odds of receiving multi-agent therapy compared to Non-Hispanic Black patients (Hispanic Black vs Non-Hispanic Black: OR=1.47, p=0.01). Patients who weren't treated in academic centers were less likely to be treated with multi-agent therapy (OR=0.75, p&lt0.0001). Those with Medicaid or Medicare were less likely to receive multi-agent regimen than those with private insurance (OR=0.88, p&lt0.0001, OR=0.86, p&lt0.0001, respectively). Patients with lower median household incomes had lower access to multi-agent therapy (OR=0.86, p&lt0.0001). Those with lower level of education were less likely to be treated with multi-agent regimens than those who were (OR=0.93, p=0.0133). KM survival curves showed significant survival benefit for patients who received multi-agent therapy. Our data indicates that when Black and Hispanic patients receive multi-agent MM therapy, they tend to have better outcomes compared to White and Non-Hispanic patients (HR=1 and 0.92 for White and Black patients respectively; HR=1 and 0.8 for Non-Hispanic and Hispanic patients respectively, p&lt0.0001).
Conclusion: In this large analysis of MM patients, we identified that Non-Hispanic Black patients and those with a lower socioeconomic status were less likely to receive the standard of care multi-agent therapy in this large cohort of real world data set from across the USA. These results further corroborate the need to provide equitable access to care, which will translate to better clinical outcomes.
Citation Format: Ludovic Saba, Chakra Pani Chaulagain, Hong Liang, Barbara Dominguez, Chieh-Lin Fu. Demographic and socioeconomic determinants to the access to multi-agent therapy in multiple myeloma: A National Cancer Database (NCDB) analysis of years 2004-2017 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1936.