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Older Patients with Myeloma: Supportive Care Underutilized

Myeloma cells.

Several facets of supportive care are important in multiple myeloma, including management of bone disease, thromboprophylaxis, and prevention of infectious disease. Appropriate supportive care measures have been outlined in well-established guidelines, but a new study reports that often, these are not followed.

For this study, which has been published in Cancer, the researchers focused on three outcomes regarding guideline-recommended supportive care: the use of bone-modifying drugs (BMDs) within the 12 months following diagnosis, influenza vaccination in the first season following diagnosis, and concomitant use of prophylactic antivirals with proteasome inhibitors. The investigators, who are from the Yale School of Medicine and the Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, utilized the Surveillance, Epidemiology, and End Results (SEER)—Medicare database to identify 1,996 adults aged 66 or older who were diagnosed with multiple myeloma between the years 2008 and 2013 and received active treatment and survived for at least one year following their diagnosis.

Of these patients, the researchers found that 64% received BMDs, 52% received an influenza vaccination, and 49% received antiviral prophylaxis. Non-Hispanic black patients had lower odds of receiving BMDs than did white patients, as did patients with baseline renal impairment. In addition, non-Hispanic black patients and those with dual Medicaid enrollment had lower odds of receiving an influenza vaccination. Patients treated in a community-based setting were less likely to receive antiviral prophylaxis.

"With improving survival for patients with multiple myeloma… supportive care that is focused on optimizing quality of life and minimizing treatment‐related toxicities is increasingly important," write the researchers, led by first author Smith Giri, MBBS, MHS, a hematology fellow in the Department of Internal Medicine at Yale School of Medicine. "Substantial underutilization of guideline‐recommended supportive care was observed among older adults with [multiple myeloma] in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with [multiple myeloma]."

For More Information

Giri S, Zhu W, Wang R, et al (2019). Underutilization of guideline‐recommended supportive care among older adults with multiple myeloma in the United States. Cancer. [Epub ahead of print] DOI:10.1002/cncr.32428

Image credit: KGH. Licensed under CC BY-SA 3.0

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