Multiple myeloma is a rare blood cancer of infection-fighting cells known as white plasma cells. It can be devastating and deadly for anyone, but it’s particularly so for minorities such as Blacks and Hispanics. Both Blacks and Hispanics are more likely to get the disease, see symptoms earlier, and have more complications such as anemia or kidney disease.
Why are there health disparities?
There may be several reasons why certain minorities are more at risk, both to develop myeloma and to die from it. They include:
Delays in diagnosis. In Black communities, even among primary care doctors, there may not be enough awareness about multiple myeloma itself. If someone has symptoms of multiple myeloma, it may be dismissed as part of aging. These include:
- Back pain
- Peeing a lot
- Trouble with bowel movements
Differences in health care. Only about half of Blacks under the age of 65 and 28 percent of those over 65 have private insurance. Research shows that minority multiple myeloma patients who have Medicaid or Medicare are much less likely to get new treatments compared to minority patients with private insurance.
Lack of access to the best treatments. Black patients are 50 percent less likely to get a stem cell transplant or to be treated with drugs, which are the standard of care for people with multiple myeloma. Research also suggests Hispanics are even less likely than Blacks to get a stem cell transplant and have limited access to new therapies and clinical trials. As a result, they have poorer health outcomes.
More risk factors. It’s not clear why Blacks and Hispanics are at greater risk. It may be because of environmental factors such as radiation exposure. It may also be due to genetic reasons. Black patients are more likely to have certain gene mutations that raise their chances of getting multiple myeloma. They are also more likely to have conditions such as anemia or increased levels of a substance called lactate dehydrogenase (LDH), both of which are associated with high-risk myeloma. Once they do develop this blood cancer, their risk is higher for severe kidney disease, as well as hypercalcemia, or high calcium blood levels, which can cause bone weakening.
Why is it so important to remove treatment barriers?
Studies do show that when minority patients get standard access to care, they have the same or better outcomes. For example, when Blacks get the right treatments, they often have a better outlook and better overall survival in living with multiple myeloma. This may be because even though this cancer affects Blacks at greater rates, it tends to be less aggressive. That’s why it’s so important for minorities to get the same care, including access to cutting-edge treatments.
Unfortunately, that doesn’t usually happen. One study found that Black and Hispanic people with multiple myeloma usually start treatment with a new therapy later than white patients. On average, it happens about 5 months after diagnosis, compared to white patients, who began around 3 months. But if treatment is delayed, patients are more likely to have complications such as anemia, bone fractures, infections, kidney problems, and even organ damage.
They also have less chance of survival. The study also found that Hispanics were also less likely than Blacks or whites to undergo a stem cell transplant. Medical costs for both Blacks and Hispanics were also higher, which may be due to higher hospitalization costs for complications due to delayed treatment.
How can we address these barriers?
There are ways people of color can advocate for themselves and get better care. These include:
Make sure you’re getting the right treatment. There are many different treatments for multiple myeloma. These include drug treatments like proteasome inhibitors or monoclonal antibodies, stem cell transplants, and new drugs that block a certain protein found on myeloma cells. It’s important to be your own best advocate. When you don’t understand or are unsure about something, always ask.
Ask your doctor about clinical trials. These are another important treatment option for people who live with multiple myeloma. It is a way for researchers to determine if a drug is safe and effective. Although Blacks with multiple myeloma make up 1 out of every 5 people who live with multiple myeloma, for example, they represent less than 10 percent of people in clinical trials.
Get help with your health care. If paying for treatment is a concern, there are many groups and programs that can help. But assistance isn’t just limited to finances. Start with an internet search, or ask your doctor for a referral to the hospital’s social worker. They often have the inside track on such programs.
It will take time to achieve racial equity when it comes to treatment for multiple myeloma. But increased awareness, advocacy, and the removal of health care barriers will go a long way toward getting us there.
Photo Credit: Cavan Images / Getty Images
International Myeloma Foundation: “What are some disparities in the treatment and care of multiple myeloma patients?”
Multiple Myeloma Research Foundation: “Multiple Myeloma in African Americans,” “Drug Therapies for Multiple Myeloma.”
National Cancer Institute: ”Multiple Myeloma Awareness and African American Disparities.”
Moffitt Cancer Center: “Do Racial and Ethnic Differences Impact Outcomes in Multiple Myeloma?”
International Myeloma Foundation: “What is the IMF African-American Initiative?”
Myeloma Central: “Get the Facts About Multiple Myeloma in African Americans.”
Blood Advances: “Racial Disparities in Treatment Patterns and Outcomes Among Patients with Multiple Myeloma.”
Cancer Medicine: “Racial disparity in utilization of therapeutic modalities among multiple myeloma patients: a SEER-medicare analysis.”