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Devarakonda et al. Impact of insurance on overall survival

noted to be 6.2 years compared to 5.1 years in the impact of health care insurance on the outcomes of
African American group (P = 0.517). Likewise, gender patients with multiple myeloma. Previous studies
had little impact on survival as there was only a slight examined the role of poverty and socioeconomic
but not statistically significant increase in survival in status on the outcome of patients with MM but until
female patients with MM with a mean survival of 5.4 now there was no study looking into the role of
years for females vs. 5.1 years for males (P = 0.748). health care insurance on the survival of patients with
Follow up of patients with MGUS at 8.3 years revealed this disease. In our study, we found that the funded
that 73% of funded patients were alive as compared patients diagnosed with MM and MGUS, the precursor
to 50% in the non-funded group (P = 0.03).The overall of MM, have significantly better median, 5-year and
survival of patients when classified according to stage overall survivals than patients without insurance. The
was 12.8 years for stage 1, 4.3 years for stage 2, 5.1 insurance status was analyzed at the time of diagnosis
years for stage 3A and 3.3 years for stage 3B (P < and did not take into account change of insurance
0.0001). Although the stage distribution was similar status during the course of the illness. It could be
in the funded and non-funded groups at the time of presumed that funded patients had better access to
diagnosis, within each stage the funded patients had medical care, thereby allowing for earlier diagnosis;
improved survival. P-values to compare the survival less advanced disease, and hence improved survival.
difference between funded and non-funded groups for However, there was no statistically significant
stage 1, 2, 3a, and 3b were 0.098, 0.267, 0.039, and difference in the distribution of disease stage between
0.123, respectively. the funded and non-funded groups. Another feature
of MM that could potentially influence the outcomes is
DISCUSSION the biology of the disease as reflected by the presence
of disease risk features. However, the Mayo Clinic risk
We have conducted the first study to examine the stratification criteria were similarly distributed between

Figure 1: Two hundred and fifty-seven patients with multiple myeloma or MGUS diagnosed and treated. (A) Overall survival of patients
with multiple myeloma; (B) comparison of overall survival of multiple myeloma based on race; (C) comparison of overall survival of
multiple myeloma based on funding; (D) comparison of overall survival of MGUS based on funding. MGUS: monoclonal gammopathy of
undetermined significance
102 Journal of Cancer Metastasis and Treatment ¦ Volume 3 ¦ June 9, 2017