New and more advanced treatments are helping people with multiple myeloma live longer. But the outlook hasn't improved at the same pace for everyone with this blood cancer.
Black people with multiple myeloma have a shorter life expectancy than white people. And both Black and Hispanic people may not get treated as quickly, or with the same therapies, as people of other races.
Everyone has the right to the best possible cancer care. Research shows that people of all races can do equally well when they have the same access to treatment. If you've been diagnosed with multiple myeloma and you don't think you're getting the treatment you need, there are things you can do to advocate for yourself.
How Race Affects Outcomes
Multiple myeloma doesn't affect people of all races in the same way. Black people are more than twice as likely to get this cancer as white people. Hispanic people also face a slightly higher risk than non-Hispanic white people.
Both Black and Hispanic people are diagnosed at younger ages than white people. They're also more likely to be diagnosed once they already have kidney damage, a common multiple myeloma complication.
Higher rates of obesity could be why Black and Hispanic people are more likely to get this cancer. Being overweight is one of the main risks for multiple myeloma.
Differences in Drug Treatment
Treatment for multiple myeloma has made huge leaps forward in recent years. Drugs called proteasome inhibitors and immunomodulatory drugs have replaced chemotherapy as the main treatment because they work so much better. But Black and Hispanic people often aren't getting these new treatments at the same rates as white people.
The standard first treatment for multiple myeloma today is induction therapy with a combination of three drugs. Often that combo includes:
- Bortezomib (Velcade), a proteasome inhibitor
- Dexamethasone, a steroid
- Lenalidomide (Revlimid), an immunomodulator
Studies show that taking all three drugs improves survival. The earlier you start treatment, the better your outcome will be.
Yet people of color are less likely to be prescribed new treatments like Velcade and Revlimid than white people. They also tend to start their treatment later. Treatment delays might increase the risk for multiple myeloma complications like infections, anemia, and kidney damage. Waiting to start treatment could also affect survival.
Access to Stem Cell Transplants
After taking the three-drug treatment, people who are healthy enough will have a stem cell transplant. This treatment starts with chemotherapy to kill the abnormal blood cells in bone marrow, followed by a transplant of healthy blood-forming cells.
Minorities are less likely to get cell transplants than white people, even though people of all races do equally well after having this treatment. Hispanics have the lowest rate of stem cell transplant in the United States. The reason for this isn't clear.
The High Cost of Cancer Care
New cancer drugs come with a high price tag. Treatment is often out of reach for people who don't have health insurance. Research finds that fewer Black and Hispanic people have health insurance than white people.
Even though Black people are less likely to get new treatments and stem cell transplants than white people, they pay higher monthly health care costs. This may be because they have more aggressive cancer or they start treatment later, after their cancer has already worsened.
Breaking Down Barriers
When people of color do have equal access to care, survival differences disappear. Everyone who gets treatment at Veterans Affairs (VA) hospitals has access to the same treatments and can get a stem cell transplant. In a study done at the VA, Black people had the same survival rates as white people.
Breaking down barriers to care starts with increasing diversity in clinical trials. Every multiple myeloma treatment we use today started in a clinical trial. These studies test new medications to see how well they work and if they're safe.
But in general, Black and Hispanic people aren’t taking part in these studies. Out of 78 studies done from 2000 to 2016:
- 84% of participants were white
- 8.6% were Black
- 1.8% were Hispanic
A lack of access to trial centers and distrust of the medical system are just two of the reasons why so few Black and Hispanic people enroll in studies. Without testing new drugs on different groups of people, researchers can't know how well these treatments will work, or how safe they are.
When people with multiple myeloma from minority groups do get access to clinical trials, they have better outcomes.
What You Can Do
Remember that you have the right to good health care, whether you're diagnosed with multiple myeloma or another type of cancer. The more you know about multiple myeloma and its treatments, the easier it will be for you to get the care you need.
Tell your doctor if you have symptoms so you can get tested and diagnosed early. If you don't think your doctor is taking your concerns seriously enough or giving you the usual treatments, you have the right to ask for a second opinion.
Also consider taking part in a clinical trial for multiple myeloma. You can find one through your doctor, the ClinicialTrials.gov website, or through organizations like the Multiple Myeloma Research Foundation.
Photo Credit: FatCamera / Getty images
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