The Veterans Health Administration Provides Equal Access to Autologous Hematopoietic Stem Cell Transplantation for Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2629-2629
Author(s):  
Cesar O. Freytes ◽  
Natalie S Callander ◽  
Stacey A Goodman ◽  
Suhong Luo ◽  
Juan J. Toro ◽  
...  
Keyword(s):  
Household Income ◽  
Research Funding ◽  
Equal Access ◽  
Racial Groups ◽  
Veterans Health ◽  
Health Administration ◽  
Hematopoietic Stem ◽  
Black And White ◽  
Black Patients ◽  
Income Quartile

Abstract Autologous hematopoietic stem cell transplantation (AHSCT) remains an integral part of multiple myeloma (MM) therapy. Previous studies have documented disparities in the utilization of AHSCT, with black MM patients receiving AHSCT less frequently than white patients. Among the factors that may influence AHSCT utilization is the availability and quality of health insurance. A previous analysis of black and white MM patients who underwent AHSCT in an equal access health care system, demonstrated comparable survival between black and white patients following AHSCT in MM. Unfortunately, this study did not provide information regarding potential race-based differences in AHSCT utilization. In an effort to understand the relationship between race and AHSCT utilization in an equal access healthcare system, we evaluated AHSCT utilization in a cohort of MM patients from the Veterans Health Administration (VHA) central cancer registry. Patients diagnosed with MM at any VHA medical center between September 1, 1999 and September 30, 2009 using International Classification of Diseases for Oncology, third revision, code 9732/3. Patients who did not receive treatment within 6 months of diagnosis were excluded in order to remove patients with monoclonal gammopathy or smoldering myeloma miscoded as MM (n=1,002). This resulted in a cohort of 2,968 patients. AHSCT was identified by ICD-9 procedure codes (410.4, 410.7, 410.0, 410.1, 410.9) or use of high-dose melphalan. Household income was estimated based upon zip code of residence, linked to census data on median household income by zip code. Of the 2,968 patients, 2,040 (68.7%) were white, 850 (28.6%) were black, 40 (0.1%) from other racial groups, and 38 (0.1%) were from unknown racial groups. The proportion of patients who underwent AHSCT was similar: 270 of 2118 white/other MM patients underwent AHSCT compared to 94 black patients (12.8% vs. 11%, respectively, p = 0.2). Demographics of the patients who received AHSCT are presented in table 1. Comparison of socioeconomic status demonstrated that across the entire cohort of 2,698 patients, black patients were significantly more likely to be from the lowest income quartile compared to white/other patients (38.2% vs. 18.4%, p < 0.001). Among the patients who received transplant, black patients again were more likely to come from the lowest income quartile (29.8% vs. 18.2%, p = 0.07). We conclude that the proportion of white and black patients who undergo AHSCT for MM is similar in the VHA, a finding that was present despite significant differences in estimated household income. Our finding is in contrast to previous registry studies that have shown limited access to transplantation for black MM patients. This suggests that in the VHA, utilization of high-cost interventions such as AHSCT is equal, despite differences in race and socioeconomic status. Table- Demographic and clinical characteristics by race among transplanted MM patients diagnosed 1999 to 2009 Demographic clinical characteristics Overall (N=364) White or other (n=270) Black (n=94) p-value Age (mean / range) 57.5 (27-73) 58 (27-73) 56.1 (30 - 71) 0.02 Sex (Male %) 96.7 97.4 94.7 0.2 Comorbidities (mean Charlson score) 1.4 1.3 1.6 0.09 BMI (%) <18.5 1.1 0.7 2.1 18.5-<25 22 22.2 21.3 25-<30 44.8 41.5 54.3 >=30 32.1 35.6 22.3 0.1 Estimated Household Income (%) Quartile 1 21.2 18.2 29.8 Quartile 2 23.4 23.7 22.3 Quartile 3 25.6 27 21.3 Quartile 4 27.5 28.2 25.5 Unknown 2.5 3 1.1 0.07 Hemoglobin (mean) 11 11.2 10.3 < 0.001 Creatinine (mean) 1.8 1.9 1.5 0.03 Albumin (mean) 3.3 3.4 3.3 0.3 Time(months) between Dx and transplant (mean/range) 12.8 (3.4-87.7) 12.3 (3.4-55.5) 14.1 (3.6-87.7) 0.15 Disclosures Freytes: Merck: Research Funding; Otsuka: Consultancy, Research Funding; Sanofi: Speakers Bureau. Carson:Celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Millennium: Consultancy, Research Funding.

scholarly journals Racial Differences in Multiple Myeloma Survival and Treatment Using Pooled Clinical Trial and Real-World Electronic Medical Record Data

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-9
Author(s):  
Emelly Rusli ◽  
Lihong Diao ◽  
Cynthia Liu ◽  
Mona A Kelkar ◽  
Lisa Ensign ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Median Number ◽  
Research Network ◽  
Racial Groups ◽  
Publicly Traded ◽  
Black And White ◽  
Line Therapy ◽  
Black Patients ◽  
Ct Data ◽  
White Patients

Background: Past studies have indicated a potential racial disparity in Multiple Myeloma (MM) survival between black and white patients (Costa et al., 2017; Marinac et al., 2020), an issue compounded by minority underrepresentation in clinical trials (Ailawadhi et al., 2018). To better understand how racial disparities affect both MM survival and access to treatment, we performed an analysis of pooled clinical trial (CT) and Real-World EMR Data (RWD). Methods: Eligible Phase II and III open-label MM clinical trials were identified from the Medidata Enterprise Data Store, which comprises over 22,000 historical clinical trials, for de-identified aggregate analyses. De-identified Oncology RWD was sourced from the Guardian Research Network of integrated delivery systems from 2016 to 2020. Baseline characteristics were analyzed in both cohorts. Race was categorized as black, white, or other. Overall Survival (OS) was assessed using Kaplan-Meier analysis. In the RWD, therapy utilization was assessed by race. Results: The RWD contained 5871 patients, with 17.5% black, 78.3% white, and 4.2% other race. Median age in years at diagnosis was 69 for blacks, 72 for whites, and 70 for other races. The gender breakdown was 54.2% female in blacks, 46.0% in whites, 45.9% in those of other races respectively. Median number of prior regimens was 2, with no differences between racial groups. The CT data contained 851 patients, with 1.4% black, 93.5% white, and 5.1% other race. Median age in years at diagnosis was 62 for blacks, 58 for whites, and 55 for other races. The gender breakdown was 33.3% female in blacks, 43.5% in whites, and 46.7% in those of other races respectively. Median number of prior regimens was 5, with no differences between racial groups. There was no statistically significant difference in OS between racial groups in either dataset. In the CT data with median follow-up of 7.8 years, survival from date of diagnosis to last visit or date of death was 25% for blacks and 18% for whites. Currently, in the RWD, 3-year survival comparing blacks to whites is 85% to 83%. The proportion of treated RWD patients appears to be similar between black and white patient groups, with 56% of white and 53% of black patients receiving 1st line therapy, and 33% and 31% receiving 2nd line therapy, respectively. Among newer therapy modalities, white patients had a higher utilization of targeted antibody agent daratumumab (8.7% utilization among whites, 5.2% in blacks, p&lt;0.001), and although not statistically different, proteasome inhibitor carfilzomib use was also higher among whites compared to blacks (6.5% versus 5.5%). Mono daratumumab and ixazomib were used as 1st-line therapy in white patients, while these agents were administered in combination with other treatments in black patients. Adjusting for age and novel therapy use, there was also a suggestion that treatment initiation after diagnosis occurred earlier in whites than blacks (median 1.1 years vs. 1.6 years, p=0.3). Conclusions: Though there were no demonstrated differences in survival between racial groups in either dataset, the RWD suggested differences in treatment utilization, with underutilization of novel therapies like proteasome inhibitors and targeted antibody therapy and later treatment initiation in blacks. Previous studies (Fiala et al., 2017) have noted similar trends, which suggest that therapeutic advances may not be equitably available to all racial groups. This observation could not be replicated in CT data, but merits further exploration. Despite black patients making up 17.5% of patients in the RWD, a racial distribution consistent with published literature (Rosenberg et al., 2015), black patients made up only 1.3% of patients in the CT data. Furthermore, in the CT data, the median age of black patients was older than that of the white and other race groups (62 years compared to 58 and 55, respectively). This observation is magnified by evidence in both the RWD and other datasets (Fillmore et al., 2019) that shows a younger age of onset in black MM patients. Given the strong correlation between age and poorer outcomes in MM (Ludwig et al.,2008), it is possible that these clinical trials are not capturing a representative black patient population, and results may not be generalizable to other groups. Recruitment of black patients should remain a priority in clinical studies in order to effectively assess racial disparities in MM treatment access and survival. Disclosures Rusli: Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company. Diao:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Liu:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Kelkar:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment. Ensign:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company. Watson:Guardian Research Network, Inc.: Current Employment. Galaznik:Acorn AI by Medidata, a Dassault Systemes Company: Current Employment, Current equity holder in publicly-traded company.

Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009–2014

2019 ◽  
Vol 8 (16) ◽  
pp. 1365-1379 ◽  
Author(s):  
Hyun S Park ◽  
Robert S White ◽  
Xiaoyue Ma ◽  
Briana Lui ◽  
Kane O Pryor
Keyword(s):  
New York ◽  
Household Income ◽  
Odds Ratio ◽  
Insurance Status ◽  
Median Income ◽  
Median Household Income ◽  
Discharge Data ◽  
Black Patients ◽  
Race Ethnicity ◽  
Income Quartile

Aim: To examine the effect of race/ethnicity, insurance status and median household income on postoperative readmissions following colectomy. Patients & methods: Multivariate analysis of hospital discharge data from California, Florida, Maryland and New York from 2009 to 2014. Primary outcomes included adjusted odds of 30- and 90-day readmissions following colectomy by race, insurance status and median income quartile. Results: Total 330,840 discharges included. All 30-day readmissions were higher for black patients (adjusted odds ratio [aOR]: 1.07). Both 30- and 90-day readmissions were higher for Medicaid (aOR: 1.30 and 1.26) and Medicare (aOR: 1.30 and 1.29). The 30- and 90-day readmissions were lower in the highest income quartiles. Conclusion: Race, insurance status and median household income are all independent predictors of disparity in readmissions following colectomy.

scholarly journals Survival by race in men with chemotherapy-naive enzalutamide- or abiraterone-treated metastatic castration-resistant prostate cancer

2021 ◽  
Author(s):  
Daniel J. George ◽  
Krishnan Ramaswamy ◽  
Ahong Huang ◽  
David Russell ◽  
Jack Mardekian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Black Men ◽  
White Men ◽  
Subsequent Treatment ◽  
Veterans Health ◽  
Health Administration ◽  
Castration Resistant Prostate Cancer ◽  
Cox Models ◽  
Black And White ◽  
Castration Resistant

Abstract Background Black men are more likely to be diagnosed with aggressive prostate cancer (PC) and die from PC than white men. However, black men with metastatic castration-resistant PC (mCRPC) had longer overall survival (OS) than white men when treated with certain agents in clinical trials. We analyzed claims data from the Veterans Health Administration (VHA) database to evaluate OS in black and white men treated with enzalutamide or abiraterone (novel hormonal therapy [NHT]) for chemotherapy-naïve mCRPC. Methods Patients with mCRPC aged ≥18 years were identified in the VHA database by diagnosis codes, evidence of surgical/medical castration, and a prescription claim for enzalutamide or abiraterone after castration from April 2014–March 2017. Cox models assessed associations between race and OS. Unadjusted and multivariable analyses were performed on the entire population and subsets based on the type of therapy received (if any) after NHT. Results In total, 2910 patients were identified (787 black, mean 71.7 years; 2123 white, mean 74.0 years). Median follow-up was 19.0 and 18.7 months in blacks and whites, respectively. Black men had better survival versus white men: hazard ratios (95% CIs) were 0.89 (0.790–0.996; P = 0.044) and 0.67 (0.592–0.758; P < 0.0001) in the unadjusted and multivariable models, respectively. Statistically significantly longer OS was seen in black versus white men regardless of subsequent treatment, including no subsequent treatment. Conclusions In the VHA, black men with chemotherapy-naïve mCRPC initiating NHT may have better outcomes than similarly treated white men.

Racial Disparities in Cell of Origin Among DLBCL Patients.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2686-2686 ◽  
Author(s):  
Christopher R. Flowers ◽  
Loretta Nastoupil ◽  
Uma Borate ◽  
Pareen J Shenoy ◽  
Will Donnellan ◽  
...  
Keyword(s):  
United States ◽  
Cohort Study ◽  
B Cell ◽  
Racial Disparities ◽  
Treatment Outcomes ◽  
Research Funding ◽  
Performance Status ◽  
Black And White ◽  
Black Patients ◽  
Baseline Characteristics

Abstract Abstract 2686 Background: DLBCL is the most commonly occurring form of non-Hodgkin lymphoma and is a highly curable disease, but one that is universally fatal if untreated or improperly treated. In a series of studies, we have reported racial disparities in the clinical presentation and the treatment outcomes for patients (pts) with DLBCL in the United States (Shenoy Cancer 2010; Flowers CEBP 2012). These studies showed that black pts with DLBCL are diagnosed at an age a decade younger than whites, are more likely to have advanced stage disease, and are less likely to survive 5 years. One explanation is that black patients in the US less often receive standard of care therapy (Flowers CEBP 2012). However, in a cohort study of 533 white and 144 black patients with DLBCL managed at Emory and University of Alabama-Birmingham (UAB) black race predicted worse overall survival (OS) even when black and white pts received the same therapy (CHOP; Hazard ratio [HR] 1.8, p<0.001) suggesting a biological basis for some disparities(Flowers Leuk Lymph 2012). To address these findings, we examined whether known prognostic biological variants within DLBCL [germinal center B-cell-like (GCB) and activated B-cell like (ABC)] occurred differentially between black and white pts. Methods: DLBCL pts within our Emory-UAB cohort study provided formalin fixed material available for construction of tissue microarrays (TMAs). All pts were diagnosed with DLBCL from 1990–2010 and met the following criteria: age ≥18 years at diagnosis and available information on demographics, race, gender, initial clinical features at presentation, treatment, and treatment outcomes. H&E slides from each block for each case were reviewed to identify the appropriate zone(s) for cores. Sections placed in TMAs underwent immunohistochemistry (IHC) staining with BCL6, GCET1, CD10, FOXP1, and LMO2 antibodies. The percentages of positive cells were scored in 10% increments for each antibody, and recorded for each case by 3 hematopathologists blinded to the clinical and demographic data. The Choi algorithm was used to classify all patients into ABC and GCB subsets; other IHC algorithms were used as a backup. Descriptive statistics for the baseline characteristics of black and white pts were compared using Chi-square tests. Kaplan–Meier estimation was used to evaluate OS for the two groups and compared with the log-rank test. To evaluate prognostic factors and the effects of treatment on OS, Cox proportional hazards models were used controlling for age, sex, stage, LDH, performance status, presence of B-symptoms, race, treatment (R-CHOP vs. other), and ABC subtype. Results: Tissues for 26 black pts and 63 white pts meeting all eligibility criteria were evaluated in the TMA. There were significant differences in baseline characteristics between the two groups; 23% of black pts vs. 46% of whites were > 60 years of age (p=0.04), 73% had stage III/IV disease vs. 56% (p=0.03), and 77% had an LDH>ULN vs. 51% (p=0.04). There were no significant differences between the two racial groups in terms of sex, ECOG PS, presence of B-symptoms (38% vs. 29%p=0.46), extranodal sites (50% vs. 78% ≤ 1, p=0.27), IPI risk, or treatment received (RCHOP 46% vs. 40% p=0.93). By the Hans, Natkunam, Tally, and Choi algorithms black patients more commonly presented with the poor-risk ABC/non-GCB subtype (by Choi black 64% ABC vs. white 37%; p= 0.01, Table). After controlling for clinical confounders including age, sex, stage, LDH, performance status, presence of B-symptoms, race, treatment (RCHOP vs. other), and ABC subtype, being >60 years of age [HR 3.1 95% CI 1.3–7.2], being black (HR 3.5 95% CI 1.5–8.2), and receiving treatment other than RCHOP (HR 12.8, 95% CI 3.2–50.6) were associated with inferior OS. Conclusions: The rate of ABC DLBCL is significantly higher in black pts compared to white pts in this university-based cohort from the Southern United States. Additional studies confirming these findings in larger populations and examining the mutations associated with these differences are underway to address biological differences intrinsic to DLBCL that may in part explain comparatively adverse features and outcomes for black pts with DLBCL. Disclosures: Flowers: Celgene, Spectrum, Millennium, Gilead, Janssen: Research Funding; Genentech/Roche (unpaid), Millennium (unpaid), Celgene: Consultancy. Bernal-Mizrachi:Empire Genomics (not related to current work): Patents & Royalties. Sinha:Celgene: Research Funding. Jaye:Millenium Pharmaceuticals (For single lecture on immunohistochemical subtyping of large B cell lymphomas): Honoraria.

scholarly journals Race-Based Differences in Routine Cytogenetic Profiles of Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2619-2619
Author(s):  
Brandon Jamaal Blue ◽  
Kristen M. Sanfilippo ◽  
Arun Ganti ◽  
Jason Gumbel ◽  
Katiuscia O'Brian ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Racial Differences ◽  
Hematologic Malignancy ◽  
Molecular Testing ◽  
Veterans Health ◽  
Health Administration ◽  
Chromosome 14 ◽  
Exact Test ◽  
Black Patients ◽  
White Patients

Abstract Background: Multiple myeloma (MM) is a common hematologic malignancy for which standard therapy does not offer a cure. Incidence of MM in African-Americans is twice that of Caucasians, suggesting differences in either environmental or genetic risk factors. Historically, black patients have also had a slightly better prognosis than white patients, suggesting racial differences in prognostic factors such as cytogenetics. Since metaphase cytogenetic profiles are routinely collected in MM patients, we sought to determine if race-based differences in cytogenetics exist, using data from the Veterans Health Administration (VHA) cancer registry. Methods: Using CPT codes, 88271-88275, 88291, 88299, 88365, 83896, 88237, 88261-88264, 88280, 88283, and 88285, we identified 988 patients with MM diagnosed between 1998 and 2009, who also had standard metaphase cytogenetic analysis performed on a bone marrow specimen at the time of diagnosis (228 Black and 585 White) . Fisher’s exact test was used to assess for race-based differences in the following cytogenetic abnormalities: 13q deletion, Hypodiploidy, Hyperdiploidy, and translocations involving chromosome 14. Results: Among the 988 patients in the cohort, normal cytogenetic profiles, isolated Y chromosome deletion, or no mitotic activity were observed in 704(71%) patients. Translocations involving the immunoglobulin heavy chain (chromosome 14) (n=4) were uncommonly observed on routine cytogenetics, such that no statistical conclusions could be drawn. Hyperdiploidy was noted in 13/228(5.7%) of the black and 45/585(7.7%) of the white patients (p=0.32). Similarly 13q deletions were detected in 8/228(3.5%) black patients, and 21/585(3.6%) of the white patients (p=0.96). Hypodiploidy was also not significantly different in black 4/228(1.8%) and white patients 12/585(2.0%). Conclusion: This is the largest study of race-based differences in MM cyogenetics presented to date. We found no significant race-based differences in standard metaphase cytogenetics. Future studies should focus on determining if race-based differences can be discovered using fluorescent in situ hybridization (FISH) or molecular testing not available for this retrospective study. Our study adds to this growing body of evidence suggesting that metaphase cytogenetic differences are not a significant factor in MM outcome disparities. Disclosures Carson: Spectrum Pharmaceuticals: Honoraria, Research Funding, Speakers Bureau.

scholarly journals Uptake of Novel Agents (NAs) As First-Line Treatments for Black and White Patients with Chronic Lymphocytic Leukemia (CLL) in the Veterans Health Administration (VHA): A Retrospective Cohort Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 340-340
Author(s):  
Kana Tai Lucero ◽  
Obiageri O. Obodozie-Ofoegbu ◽  
Zohra Nooruddin ◽  
Alyssa Castillo ◽  
Amanda M. Moore ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Research Funding ◽  
Lymphocytic Leukemia ◽  
Fiscal Year ◽  
First Line ◽  
Black And White ◽  
Disease Biology ◽  
Black Patients ◽  
Baseline Characteristics ◽  
White Patients

Abstract Introduction Since the introduction of NAs in 2013, the treatment paradigm for CLL has changed significantly with the increased uptake of NAs for first line (1L) and refractory CLL. NA have introduced a personalized approach to CLL treatment that considers patient baseline characteristics, individual risk factors and preferences. 1 Despite improvement in survival outcomes with CLL, Black patients with CLL have demonstrated inferior overall survival as compared to White patients. 2 Studies have shown a difference in disease biology between Black and White patients. 3 Differences in disease biology and access to medical care and treatment have contributed to racial disparities. The purpose of this study was to assess the uptake of NAs in the VHA where access to care is equal for both Black and White patients. Methods: A retrospective study was conducted which observed adult patients with an ICD code for CLL managed in the VHA from 2014 to 2017. Electronic and manual data was extracted to review start and stop dates for 1L CLL therapies. Data up to twenty years prior to the CLL treatment initiation date was reviewed to define the baseline variables. Descriptive statistics were used to summarize the data, and chi-square and Student's t-tests were used to compare NA use, baseline characteristics, healthcare resource use, and complications. A two-step nominal logistic regression model was used to determine the effect of race on receipt of NAs. Baseline patient characteristics were compared with bivariable statistical tests and variables with a p-value less than 0.10 were subsequently entered into the multivariable nominal logistic regression model. P-values less than 0.05 were considered statistically significant Results: The study included 565 patients; 86% were White and 14% were Black. Black patients were younger than White patients with a median age of age 66 and 69 respectively, p&lt; 0.0001 (Table 1). Overall, Black patients were less likely to receive NAs than White patients (14% vs. 26%, p=0.0165) (Table 1). However this difference narrowed over the study period. (Figure 2) Traditional chemotherapy/chemoimmunotherapy (CT/CIT), was more common in Black patients. White and Black patients experienced similar treatment outcomes and health care utilization (Table 2). When all baseline variables listed in Table 1 were compared for Black and White ptients, the following variables had p-values less than 0.10 and were subsequently entered into a multivariant model: patient age (p&lt;0.0001), male sex (p=0.0901), peptic ulcer disease (p=0.0981), deep vein thrombosis (p=0.0976), intestinal disorders (p=0.0252), priority group 7-8 (p=0.0561), use of antihypertensives (p=0.0302), and fiscal year. In the multivariant model, with NA use as the dependent variable, Black race as the independent variable, and divergent baseline characteristics as the covariates, the only variables that were independently predictive of NA use were Black race (p=0.0243, OR=0.47, 95%CI=0.24-0.94) and fiscal year (p=0.0019). Conclusions: In this retrospective cohort study, there was a statistically significant difference in the use of NAs between Black and White patients with CLL in the VHA for the study period. However, when NA use was examined by year, the disparity was largest in the early study years with reduced differences in NA utilization over time. Potential limitations of this study include the smaller number of patients, biologic factors that were not captured, and potential confounding factors such as physician experience with NA use. With the introduction of more NAs, the VHA should pay close attention to ensure all patients receive equal access to new therapies. We hope to implement interventions to ensure that patients of all races have equal access to NAs as soon as they are introduced. References 1. Burger, J, O'Brien, S. Evolution of CLL treatment - from chemoimmunotherapy to targeted and individualized therapy. Nat Rev Clin Oncol. 2018 Aug;15(8):510-527. 2. Sikander Ailawadhi, Dongyun Yang, Nidhi Jain, Mie Mie Thinn, Wendy Cozen, Asher Chanan-Khan; Ethnic Disparities in Chronic Lymphocytic Leukemia Survival: A SEER Database Review. Blood 2012; 120 (21): 757. 3. Flowers, RC, Po, B. Racial differences in chronic lymphocytic leukemia. Digging Depper. 2013 Oct 15;119(20):3593-5. Figure 1 Figure 1. Disclosures Obodozie-Ofoegbu: University of Texas at Austin: Ended employment in the past 24 months. Nooruddin: AstraZeneca: Research Funding. Ryan: AstraZeneca: Current Employment, Current equity holder in publicly-traded company. Jones: AstraZeneca: Research Funding. Frei: AstraZeneca: Research Funding.

Understanding racial disparities in survival among U.S. veterans with localized high-risk prostate cancer, 2004-2019.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 202-202
Author(s):  
Ravi Bharat Parikh ◽  
Sumedha Chhatre ◽  
Ruchika Talwar ◽  
Elina Medvedeva ◽  
John Cashy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Racial Disparities ◽  
Veterans Health Administration ◽  
Equal Access ◽  
Localized Prostate Cancer ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Health Record Data ◽  
Term Survival

202 Background: Known racial disparities in prostate cancer outcomes between African-American (AA) and non-Hispanic White (W) men may be ameliorated in the Veterans Health Administration (VA), a large national equal-access health system. We examined factors contributing to racial disparities in mortality among men with high-risk localized prostate cancer diagnosed in the VA. Methods: In this retrospective cohort study, we used linked administrative, survey, and electronic health record data from the Veterans Health Administration (VA) Corporate Data Warehouse to identify AA and W Veterans who were diagnosed with high-risk localized PC, as defined by D’Amico criteria, between January 1, 2004 and December 31, 2013. Patients were followed through December 31, 2019. The primary outcome was all-cause mortality. We used hierarchical Cox regression models, sequentially adjusting for covariates related to social determinants of health (e.g. travel time, marital status), clinical factors at diagnosis (e.g. PSA, Gleason, comorbidity), diagnosing facility, and prostate cancer treatment and adherence to American Cancer Society survivorship care guidelines. Results: Among 21,338 Veterans receiving continuous VA-based care (median age at diagnosis 66 years [interquartile range [IQR] 61-74]), 7,472 (28.7%) were AA, 9,404 (44.1%) died, and median follow-up was 8.4 years (IQR 6.1-11.1). After adjusting for all covariates, AA Veterans (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.83-0.91) had improved overall survival compared to W Veterans. This association persisted in all hierarchical regressions (see Table), was present in all pre-specified subgroups, and was strongest among Veterans living in rural domiciles (aHR 0.70, 95% CI 0.64-0.77). Conclusions: AA Veterans with high-risk localized prostate cancer had improved long-term survival compared to W Veterans, which stands in contrast to prior studies among non-Veterans. Equal access to care may improve racial disparities in prostate cancer, although future studies should clarify mechanisms of improved survival for AA Veterans with prostate cancer in order to provide insights for ameliorating outcome disparities in non-Veterans with prostate cancer. [Table: see text]

scholarly journals Comparable Overall Survival with Rituximab-Bendamustine (R-Benda) and Rituximab-Gemcitabine-Oxaliplatin (R-GemOx) When Used As Second-Line (2L) Treatment for Diffuse Large B-Cell Lymphoma (DLBCL): A Real-World Study Using US Veterans Health Administration Data

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1711-1711 ◽  
Author(s):  
Raluca Ionescu-Ittu ◽  
Aijing Shang ◽  
Nancy Vander Velde ◽  
Annie Guérin ◽  
Yilu Lin ◽  
...  
Keyword(s):  
Real World ◽  
Research Funding ◽  
Veterans Health Administration ◽  
Treatment Patterns ◽  
Veterans Health ◽  
Health Administration ◽  
Real World Data ◽  
Analysis Group ◽  
Kaplan Meier

Abstract Introduction: DLBCL is the most common subtype of non-Hodgkin lymphoma. R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone) is established as the standard of care for patients (pts) with previously untreated DLBCL, but ~40% of pts will eventually relapse. For relapsed/refractory pts who are ineligible for transplant, clinical guidelines propose a broad spectrum of therapeutic options. However, little is known about treatment patterns and outcomes associated with 2L therapy in routine practice, particularly for pts less suitable for intensive therapy. Therefore, using real-world data, we evaluated 2L treatment patterns in DLBCL pts and overall survival (OS) in those pts who received 2L R-Benda or R-GemOx. We focused on these 2 treatments as they are typically used in the non-transplant setting in pts less suitable for aggressive therapy, and can typically be administered in an outpatient setting. Methods: DLBCL pts receiving care from the US Veterans Health Administration were identified through their electronic medical records and raw oncology domain. Pts diagnosed with DLBCL (and no prior other types of malignancies) between 2004-2016, with ≥1-month follow-up and who received 2L treatment were included. OS (defined as time from the start of 2L therapy until death) was analyzed in pts who received 2L R-Benda or R-GemOx using the Kaplan-Meier method. Surviving pts were censored at data cutoff (December 31, 2017). Univariate and multivariate Cox regression analyses were undertaken to assess the impact of 2L treatment (in particular, R-GemOx vs R-Benda) on OS. Results: A total of 2600 DLBCL pts were identified: 2039 received 1L and 702 received 1L and 2L therapy. Among the 702 pts treated with 2L therapy, regimens included R-ICE (n=77; 11.0%), R-CHOP (n=75; 10.7%), rituximab monotherapy (n=34; 4.8%), R-Benda (n=32; 4.6%), methotrexate (n=24; 3.4%), R-ESHAP (n=23; 3.3%), R-DHAP/R-EPOCH/R-GDP (n=18; 2.6%), rituximab plus cyclophosphamide-doxorubicin-vinblastine-vincristine (n=14; 2.0%), R-CVP (n=11; 1.6%), rituximab plus cyclophosphamide-etoposide-vincristine (n=11; 1.6%), and R-GemOx (n=10; 1.4%). Of the remaining pts, 267 (38.0%) received regimens with agent(s) included in the NCCN guidelines, while 106 (15.1%) received regimens with at least 1 agent not guideline-recommended. Baseline characteristics for pts treated with 2L R-Benda (n=32) or R-GemOx (n=10) are shown in Table 1. There was an imbalance between the 2 cohorts with regard to race, number of involved lymph nodes, B symptoms, Charlson Comorbidity Index score, and abnormal lactate dehydrogenase results. After 24 deaths in the R-Benda cohort and 7 deaths in the R-GemOx cohort, median OS was estimated at 11 and 13 months, respectively (Figure 1). Median follow-up time after start of 2L treatment was 11.3 and 11.7 months, respectively. The Kaplan-Meier curves of the 2 cohorts overlapped at multiple timepoints during follow-up. Respective 1-year OS rates (95% confidence interval [CI]) with R-Benda and R-GemOx were 50.0% (31.9%, 65.7%) and 60.0% (25.3%, 82.7%). Compared with R-Benda, R-GemOx did not significantly predict longer OS in either the univariate (hazard ratio [HR]: 0.94; 95% CI: 0.41, 2.19; p=0.893) or multivariate (HR: 1.07; 95% CI: 0.46, 2.50; p=0.873) analyses. Conclusions: This real-world study highlights the diversity of 2L treatment regimens used in DLBCL pts. There was no apparent difference in OS between R-Benda- and R-GemOx-treated pts and, with a median OS of approximately 1 year after 2L initiation with either regimen, there is clearly an unmet need in this setting. The main limitation of the study relates to the small sample size of each treatment cohort. Further research using other real-world data sources is warranted. Disclosures Ionescu-Ittu: Analysis Group, Inc.: Employment; F. Hoffman-La Roche Ltd: Consultancy, Other: I am an employee of Analysis Group, Inc., which received consulting fees from Roche for the conduct of this study. Shang:F. Hoffmann-La Roche Ltd.: Employment, Other: Ownership interests non-PLC. Guérin:F. Hoffman-La Roche Ltd: Other: I am an employee of Analysis Group, Inc., which received consulting fees from Roche for the conduct of this study; Analysis Group, Inc.: Employment. Shi:F. Hoffman-La Roche Ltd: Research Funding; Bravo4Health: Other: Ownership interests non-PLC; Genentech: Research Funding; Chiasma: Research Funding; Intuitive Surgical: Consultancy. Shi:F. Hoffman-La Roche Ltd: Other: I am an employee of Analysis Group, Inc., which received consulting fees from Roche for the conduct of this study; Analysis Group, Inc.: Employment. Qayum:F. Hoffmann-La Roche Ltd: Employment.

scholarly journals Outcomes of Black Patients with Multiple Myeloma in the Veterans Health Administration

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 840-840
Author(s):  
Martin W. Schoen ◽  
Suhong Luo ◽  
Kenneth R. Carson ◽  
Kristen M. Sanfilippo
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Renal Function ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Black Race ◽  
Disease Biology ◽  
Black Patients ◽  
Statin Use

Abstract Background: Multiple myeloma (MM) is the most common hematologic malignancy in blacks with more than twice the incidence of non-black populations in national registry data. Prior studies have shown that blacks present with MM at an earlier age and have improved survival compared to non-blacks, contrary to the pattern in most malignancies. These findings have been theorized due to the effects of obesity, treatment variation, and disparities in care, in addition to alternate disease biology in black patients. In order to understand possible effects of race on outcomes while adjusting for confounders not available in other national datasets such as treatment, comorbidities, and baseline laboratory characteristics, we studied outcomes in a nationwide population of United States veterans with MM in the Veterans Health Administration (VHA). Methods: Patients with MM were identified by the VHA Central Cancer Registry between September 1, 1999 and December 31, 2013 and followed through December 31, 2014. Age, sex, race, body mass index (BMI), Charlson (Romano) comorbidity index, treatment (including transplant), hemoglobin (hgb), albumin, renal function (eGFR), and statin use were included. Cox proportional hazards regression modeling was used to assess the association between black race and overall survival at five years while controlling for known prognostic factors. The study was approved the Saint Louis VA Medical Center institutional review board. Results: 4805 patients were identified with MM, of which 1418 (29.5%) were black. Black patients were younger (66.2 years vs. 69.2, p<0.001) with increased mean comorbidity scores (3.7 vs. 3.0 p<0.001) compared to non-black patients. Black patients had lower mean BMI (27.0 years vs. 27.8, p<0.001) and higher rates of hgb <10 g/dL, 49.1% vs. 35.3%, p<0.001) and albumin below 3 g/dL (35.3% vs. 28.3% p<0.001) with similar rates of decreased renal function of eGFR <30 (22.1% vs. 21.2%, p=0.69) compared to non-black patients. Black patients underwent stem cell transplantation at similar rates (12.3% vs. 14.2%, p=0.09) and there no differences based on race in treatment with lenalidomide (35.1% vs. 36.0%, p=0.52), thalidomide (36.7% vs. 38.7%, p=0.20), or melphalan (32.7% vs. 34.8%, p=0.16). More black patients were treated with bortezomib compared to non-blacks (50.1% vs 44.4%, p<0.001). In unadjusted analyses, black race was associated with reduced risk of death at five years (Hazard Ratio [HR] 0.89, 95% CI 0.83-0.97). After controlling for age, comorbidity score, hgb, albumin, transplant, and treatment; black patients also had improved survival (HR 0.82, 95% CI 0.76-0.89). After adding BMI, year of diagnosis, and statin use to the final Cox model, black patients continued to have improved survival (HR 0.80, 95% CI 0.73-0.86). Conclusions: Survival of black patients with MM was improved compared to non-blacks in the VHA, a national comprehensive care delivery system. Black patients also received similar therapies compared to non-blacks, while presenting at a younger age with more comorbidities. These results are strengthened after adjusting for treatments and patient characteristics not available in other large data studies. Despite increased incidence of MM in the black population, outcomes are improved, similar to other large studies of patients in the United States. Alternate disease biology may be responsible for improved survival and further studies of MM based on race are appropriate. Disclosures Carson: Flatiron Health: Employment; Washington University in St. Louis: Employment; Roche: Consultancy. Sanfilippo:BMS/Pfizer: Speakers Bureau.

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