Modifiable Determinants of Disparities in Multiple Myeloma Treatment Patterns

项目总结/摘要 在这个K99/R 00独立之路奖优秀早期博士后研究人员 哈姆雷特Gasoyan博士概述了一个详细的建议，以加强他在癌症的研究培训 差异研究与检查治疗相关差异的可改变决定因素相结合， 多发性骨髓瘤（MM）患者。Gasoyan博士的主要目标是成为一名独立的， 癌症健康差异领域的生产调查员，研究重点是肥胖相关 癌的K99导师培训的短期培训目标是：（1）提高 癌症差异研究的知识和技能;（2）提高他分析EHR生成的技能 临床和大型行政数据的卫生服务研究;（3）获得经验和技能 需要成功地领导一个研究实验室，并与医生，社区成员， 和卫生保健政策制定者。 MM是美国第二常见的血液恶性肿瘤，估计有34，920例发病病例 2021年将发生12,410起致命事件黑人MM的发病率明显较高， 与白色个体相比，MM死亡率更高，可能是由于几个复杂的风险 因素，如遗传学和暴露于既定MM风险因素（如肥胖）的差异。 MM的治疗是昂贵的，在所有癌症部位中具有最高的终身净成本之一。虽然小说 治疗药物和方案可用，新诊断的黑人患者不太可能接受干细胞治疗。 细胞移植，使用处方口服药物来那度胺，或用三联（3药）方案治疗， 如硼替佐米、来那度胺和地塞米松。此外，黑人患者 与他们的白色同龄人相比，他们接受这些新疗法的时间更晚。鉴于治疗费用高昂， 医疗保险覆盖率可能在MM获得新疗法的种族差异中发挥重要作用。 然而，没有保险或保险不足的MM护理模式的作用没有得到很好的研究。 此外，虽然COVID-19大流行使面对面医疗护理的呈现更加 具有挑战性，特别是对来自服务不足社区的个人来说，迄今为止没有研究调查这种影响， 2019冠状病毒病大流行对MM护理模式差异的影响。 拟议研究计划的目的是（1）研究是否 决定因素 病人保险和社会保险 健康状况可以解释MM治疗模式中的种族差异，（2）评估 2019冠状病毒病大流行对MM护理模式的影响，以及（3）评估支付方类型和费用分摊安排是否 与三联方案MM诱导治疗利用率的差异相关， 口服处方药维持治疗，如来那度胺。

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.