Modifiable Determinants of Disparities in Multiple Myeloma Treatment Patterns

PROJECT SUMMARY/ABSTRACT In this K99/R00 Pathway to Independence Award for Outstanding Early-Stage Postdoctoral Researchers application, Dr. Hamlet Gasoyan outlines a detailed proposal to enhance his research training in cancer disparities research in tandem with examining the modifiable determinants of treatment-related disparities in

patients with multiple myeloma (MM). A primary goal of Dr. Gasoyan is to become an independent and productive investigator in the field of cancer health disparities, with a research focus on obesity-related cancers. His short-term training objectives for the K99 Mentored Training are to (1) advance his

knowledge and skills in cancer disparities research; (2) advance his skills in analyzing EHR-generated clinical and large administrative data for health services research; and (3) gain experience and skills required to successfully lead a research lab and engage with medical practitioners, community members,

and health care policymakers. MM is the second most common hematologic malignancy in the US with an estimated 34,920 incident cases and 12,410 lethal outcomes to occur in 2021. Black individuals have a dramatically higher incidence of MM, as well as a higher rate of MM mortality, compared with White individuals, likely due to several, complex risk

factors, such as genetics and differences in exposure to established MM risk factors, such as obesity. Treatment of MM is costly, with one of the highest lifetime net costs among all cancer sites. While novel treatment agents and regimens are available, newly diagnosed Black patients are less likely to undergo stem

cell transplantation, use prescription oral medication lenalidomide, or be treated with triplet (3-drug) regimens, such as bortezomib, lenalidomide, and dexamethasone, than their White peers. Furthermore, Black patients receive these novel therapies later compared to their White peers. Given the high cost of treatment, health

insurance coverage likely has an important role in racial disparities of accessing novel therapies for MM. Nevertheless, the role of uninsurance or underinsurance in MM care patterns was not well studied. Furthermore, while the COVID-19 pandemic has made presenting for in-person medical care even more

challenging, particularly for individuals from underserved communities, no study to date investigated the impact of the COVID-19 pandemic on disparities in MM care patterns. The aims of the proposed research plan are to (1) examine whether determinants patients' insurance coverage and social of health can explain the racial disparities in MM treatment patterns, (2) assess the effects of the

COVID-19 pandemic on MM care patterns, and (3) assess whether payer type and cost-sharing arrangements are associated with disparities in the utilization of induction therapy for MM with triplet regimens as well as maintenance therapy with prescription oral medications, such as lenalidomide.