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Devarakonda et al. Impact of insurance on overall survival

common in males than females. [7-10] The prevalence of Medical insurance status at the time of diagnosis was
MGUS is 3% in people older than 50 years and patients defined as funded if a patient had Medicaid, Medicare
with MGUS have an annual 1% risk of progression to or commercial insurance and non-funded if the patient
MM or related malignant disorder. [11-14] Advances in was coded as free-care or self-pay.
therapeutic options such as proteasome inhibitors,
immune modulatory drugs (IMDs) and stem cell Descriptive statistics were used to describe the data.
transplantation (SCT) have improved the prognosis Product limit methods were used to estimate survival
and survival of patients with MM. [15,16] Several drugs and Log rank test was used to compare survival
®
belonging to the class of proteasome inhibitors such as difference for each factor. Statistical software SAS 9.3
Bortezomib, Carfilzomib, Ixazomib, immunomodulators (SAS institute, Gary, NC) were used in the statistical
such as Lenalidomide, Pomalidomide and monoclonal data analysis. A P-value of < 0.05 was considered the
antibodies such as Daratumumab and Elotuzumab threshold for statistical significance.
have changed the landscape of treatment of multiple
myeloma in the last decade. Patients with MGUS RESULTS
undergo active surveillance for progression to MM and
do not receive active treatment. The medical records were reviewed of 257 patients
with MM or MGUS diagnosed and treated at LSUHSC
The impact of socioeconomic status has been from 1997-2012. Of these patients 208 (80.9%) had
studied in several solid organ malignancies including MM and 49 (19.1%) had MGUS. The median age
breast, colorectal, prostate and pancreatic cancer. at diagnosis was 60 years for MM and 59 years for
Health care insurance has been shown to result in MGUS patients. Of all the patients diagnosed with MM
positive outcomes in patients diagnosed with these and MGUS, 92 (37%) were Caucasians and 165 (63%)
malignancies. [17,18] Health insurance improves access were African-Americans. There was a slight female
to health care, early diagnosis and access to several predominance with 114 male (44%) and 143 female
advanced therapeutic options. Several studies have (56%) patients [Table 1]. Stratification of the patients
explored the influence of socioeconomic status on according to the stage of MM revealed 49 (23.5%)
the survival of patients with leukemia and MM. [19,20] to be stage 1, 23 (11%) to be stage 2, 95 (45.6%) to
However, these studies have not examined the effect be stage 3A and 41 (19.7%) to be stage 3B disease.
of insurance on the outcome of these hematologic When patients were classified according to their health
malignancies. We attempted to study the effect of care insurance status, 177 (69%) were funded and
health care insurance; in particular, on the outcomes of 80 (31%) were non-funded. At presentation, 23.6% of
patients diagnosed with MM and MGUS at Louisiana non-funded patients had stage 3B disease compared
State University Health Sciences Center (LSUHSC), to 18.5% in the funded group (P = 0.06). High-risk
features were seen in 16.7% of the MM patients with
Shreveport, LA, where approximately half the patient insurance as compared to 27.2% of the non-funded
population is uninsured.
patients (P = 0.29). However, the median survival was
6.2 years in the funded group compared to 3.8 years
METHODS in the non-funded group (P < 0.001) [Figure 1] with a
5-year survival for MM patients of 60% in the funded
We conducted a retrospective study of all the patients group compared to 42% in the non-funded group. The
at our institution diagnosed with and treated for MM 5-year survival for MGUS was 95% for patients with
and MGUS between the years 1997 and 2012. MM insurance and 62% for patients without insurance (P
and MGUS were defined using the International = 0.03).When the effect of race was examined the
Classification of Disease for Oncology, 3rd edition overall survival in the Caucasian group with MM was
(ICD-O-3) codes. All the data were obtained from the
electronic medical records of the cancer center at our Table 1: Patient demographics
institution and Social Security death index. Approval for MM MGUS
accessing the patient information was obtained from Age, years 59.7 (21.2-93.3) 61.0 (41.6-83.3)
the Institutional Review Board (IRB) at our institution. Race 143 (66.5%) 20 (50%)
AA
Date of diagnosis, demographic factors such as Cauc 72 (33.5%) 20 (50%)
age, gender, race, health care insurance status and Gender
95 (44.2%)
staging at the time of diagnosis were available for each Male 120 (55.8%) 19 (47.5%)
21 (52.5%)
Female
case. Durie-Salmon staging was used for staging the Insurance
patients with MM. Patients with MM were classified as Funded 121 (56.28%) 25 (62.5%)
94 (43.72%)
Non-funded
15 (37.5%)
having high risk and standard risk disease according MM: multiple myeloma; MGUS: monoclonal gammopathy of
to the Mayo clinic risk stratification for myeloma. undetermined significance; AA: African American; Cauc: Caucasian
[21]
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