Multiple myeloma (MM) is a type of blood cancer that starts deep inside the bone marrow. When MM doesn’t respond to treatment or returns after treatment, it’s called relapsed/refractory multiple myeloma (RRMM).
“Multiple myeloma is a challenging disease because it varies a lot from one patient to the other,” says Wael Harb, MD, a hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA. “Tumors have a different genetic and molecular structure, which really affects how they respond to different treatments and also how quickly you’ll become resistant or might relapse. So, although we think it’s one disease, it’s not.”
RRMM research and treatment have come a long way in recent years, but there are still many questions – especially about how Black people and people of color are affected by the disease. For example, Black people are more than twice as likely as White people to be diagnosed with MM.
Here’s what we know – and what we still need to find out – about racial and ethnic disparities in RRMM.
How Genes Affect Risk
Although it’s not common, RRMM can run in some families. Black people have a high risk of developing plasma cell disorders that can lead to MM. Black people are also more likely to have other health issues, such as anemia, which can make MM get worse. Hispanic people are more likely to have kidney issues when they’re diagnosed with MM.
Race and Ethnicity May Affect When You’re Diagnosed
Some Black people and people of color might not understand what MM is and ignore early symptoms like fatigue, weakness, and frequent peeing. Doctors may not always order tests to screen for the disease. As a result, doctors might not diagnose MM until it has advanced.
Access to Treatment Isn’t Equal
Only 28% of Black Americans over the age of 65 have private health insurance, compared with 44% of White people. That lack of coverage can be a serious barrier to care. And if you’re not White, your doctors might treat you differently. For instance, Black and Hispanic people with MM are less likely than White people to get stem cell transplants, which can be an essential part of MM treatment. Black and Hispanic people who do get stem cell transplants tend to receive the treatment much later than White people do.
Income Can Play a Role
Socioeconomic status refers to how much you earn, how secure you feel about money, and your education. “Socioeconomics might affect the survival and outcome of patients. That’s very unfortunate,” Harb says. For instance, a new treatment called CAR T-cell therapy can be lifesaving for people with RRMM. But Black patients receive it less than any other racial or ethnic group. “Patients who might be from ethnic minorities and have socioeconomic challenges are less likely to access these opportunities,” Harb says.
Lack of Trust in Doctors
If you don’t trust doctors because of past injustices or discrimination, you’re more likely to put off medical care. “That’s a problem because these treatments are lifesaving. People are living 5, 10 years longer because of them,” Harb says.
Studies show you’re more likely to connect with doctors, be candid about your symptoms, and follow through with their advice when you share the same lived experience. But nearly 64% of all doctors in the U.S. are White.
Clinical Trials Aren’t Diverse Enough
Research studies testing new drugs are crucial to finding more good RRMM treatments. Yet Black people make up only 6% of people enrolled in all cancer-related clinical trials. As a result, doctors still aren’t sure which immunotherapy drugs might work best for Black people or which types of chemotherapy could be most beneficial for them.
“Because the numbers on the clinical trials are so small, we can’t mathematically or statistically answer those questions,” says Christina Annunziata, MD, PhD, senior vice president of Extramural Discovery Science for the American Cancer Society.
Ending Racial and Ethnic Disparities
Breaking down barriers in health care requires making many changes, starting with the following:
More diverse studies. “The only way we can make progress against RRMM, and all cancers for that matter, is by doing studies,” Annunziata says. “There are so many molecular subtypes of all cancers, and particularly MM, that we really need participation of all racial subgroups, especially Black Americans.”
There is a push to increase diversity in clinical trials “because these questions are so important,” Annunziata says. “We're trying to increase communication, letting people know that a trial is available, and really getting into the underserved communities, including those in rural areas.”
Respecting people’s cultural differences. Doctors should take into account that not everyone speaks English. “[Health care teams] might have to provide material in different languages so patients are able to access it,” Harb says. “We need to understand the cultural differences and how we can help educate.”
Talking more about treatment. “Sometimes, patients don’t even realize there [are] treatment options,” Harb says. “That’s a huge problem. Patients need to understand their disease and understand how to advocate for themselves.” It’s important for people to know how to find resources, when and where to get a second opinion, and which treatment center near them specializes in RRMM treatment.
Building trust. People need to know about available clinical trials. But it’s also key to “educate people on the importance of participating in clinical research,” Annunziata says. “A lot of people can be hesitant. We really need to get out more communication and talk with doctors who already have the trust of their patients in order to get that message across.”
Show Sources
(Photo Credit: Natalia Gdovskaia/Getty Images)
SOURCES:
Christina Annunziata, MD, PhD, senior vice president of Extramural Discovery Science, American Cancer Society.
Wael Harb, MD, hematologist and medical oncologist, MemorialCare Cancer Institute at Orange Coast Medical Center; vice president of medical affairs, Syneos Health.
American Cancer Society: “Risk Factors for Multiple Myeloma.”
American Psychological Association: “Ethnic and Racial Minorities & Socioeconomic Status.”
Association of American Medical Colleges: “Do Black patients fare better with Black doctors?” “What’s your specialty? New data show the choices of America’s doctors by gender, race, and age.”
Blood Advances: “Analysis of racial and ethnic disparities in multiple myeloma US FDA drug approval trials.”
Blood Cancer Journal: “Exploring racial disparities in treatment patterns and outcomes for patients with multiple myeloma using real world data.”
Clinical Lymphoma, Myeloma, and Leukemia: “Multiple Myeloma in Hispanics: Incidence, Characteristics, Survival, Results of Discovery, and Validation Using Real-World and Connect MM Registry Data.”
Dana-Farber Cancer Institute: “Multiple Myeloma Presents Added Burden for African Americans.”
National Cancer Institute: “Multiple Myeloma Awareness and African American Disparities.”
StatPearls: “Multiple Myeloma.”
Transplantation and Cellular Therapy: “Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access.”
