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Devarakonda et al. Impact of insurance on overall survival

the funded and non-funded patients. as SCT and IMDs. As the patients came from about
60 of Louisiana’s 64 parishes (counties) it is difficult
While insurance did not appear to affect various to ascertain the exact causes of death of all the
parameters at the time of diagnosis, it is possible that patients, thereby making the calculation of disease
subsequent treatment might be adversely affected. specific survival rates difficult. With the advent of
However, at our institution the same physicians treat health care reform and insurance coverage for nearly
patients in the same clinic setting, with the same all Americans, it is possible that outcome differences
treatment protocols regardless of payer status. As will be minimized in the future. However, the effects
the possibility of treatment differences between the of insurance status on outcome presumably reflects
two groups leading to improved survival of one group the effect of various exogenous factors such as the
over the other seems less likely, our results suggest lifestyle factors including diet, exercise, alcohol,
that having health care insurance, with easier access tobacco, etc. as well as compliance issues and hence
to health care, is probably an independent predictor as these factors will not be eliminated by health care
of survival in patients with MM and MGUS. We are insurance it is important to understand how they
currently investigating whether comorbid conditions at influence the disease outcome.
the time of diagnosis are affecting response to therapy
and subsequent outcomes. It could be argued that the In conclusion, our study showed that patients with
death of patients with MGUS is usually more likely multiple myeloma and MGUS with health care
to occur from comorbidities than from progression to insurance have longer overall survival when compared
MM, as the conversion rate of MGUS to MM is 1% to non-funded patients. There was no difference in
per year, and hence since the impact of health care survival in our patient population based on race or
insurance on survival is greater in MM than MGUS, gender. Further studies are needed to explore the
the effects are more likely to be direct (diagnosing various factors through which health care insurance
earlier disease progression), particularly in view of the impacts the disease outcomes.
recent knowledge that MM is inevitably preceded by
MGUS. [3,4] Authors’ contributions
Designed the entire project, reviewed the data and
The survival differences relative to race and gender drafted the manuscript: S.S. Devarakonda, F. Turturro,
were not statistically significant. Prior studies have J. Glass
demonstrated either no difference or improved survival Contributed to finalizing the manuscript: R. Munker
for one group or the other. Most recently, analysis Analyzed the data as cancer epidemiologist: R. Shi
of the SEER data demonstrated superior survivals Assisted in the preparation of the manuscript: E. Friday
in African Americans but with improving survival in
Caucasians, but not African Americans, with time Acknowledgments
over the study period of 1973 to 2005. [6,7] The last We are grateful to all the patients and their families
observation suggested differential access to newer who have contributed to the data of this work.
therapies. However, we noted that survival was Financial support and sponsorship
similar for all stages of disease and in a preliminary
review of treatments that there were no differences None.
in use of newer modalities. Our results suggest that Conflicts of interest
the effects of socioeconomic status on outcomes can There are no conflicts of interest.
be overcome by the expertise of an academic center
where patients are treated by faculty dedicated to the Patient consent
treatment of MM. Waiver of consent and authorization was obtained
from LSU Health Internal Review Board.
The strengths of our study are that it showed
consistent results in regards to the impact of health Ethics approval
care insurance in patients with both MM and MGUS. The study has been approved by LSU Health Internal
Our finding is not the consequence of differences Review Board, IRB approval # E10-005.
in stage distribution or high-risk features, adding
impetus to the independent effect of insurance status REFERENCES
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of the influence of advanced therapeutic options such 2. Benjamin M, Reddy S, Brawley OW. Myeloma and race: a review of
Journal of Cancer Metastasis and Treatment ¦ Volume 3 ¦ June 9, 2017 103