Modifiable Determinants of Disparities in Multiple Myeloma Treatment Patterns

多发性骨髓瘤治疗模式差异的可改变决定因素

• 批准号: 10578960
• 负责人: Hamlet Gasoyan
• 金额: $ 16万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10578960
• 关键词: Adult; American; Area; Award; Biology; Black Populations; Bortezomib; COVID-19 pandemic; COVID-19 pandemic effects; Cancer Center; Caring; Cessation of life; Clinical; Communities; Complex; Cost Sharing; Data; Databases; Deductibles; Dexamethasone; Diagnosis; Disparity; Drug Prescriptions; Electronic Health Record; Exposure to; Genetic; Goals; Health; Health Insurance; Health Policy; Health Services Research; Healthcare; Hematologic Neoplasms; Incidence; Individual; Inpatients; Insurance; Insurance Coverage; Knowledge; Lead; Maintenance Therapy; Medicaid; Medical; Medicare; Mentors; Multiple Myeloma; Neoadjuvant Therapy; Newly Diagnosed; Obesity; Obesity associated cancer; Oral; Outcome; Outpatients; Pathway interactions; Patients; Patterns of Care; Persons; Pharmaceutical Preparations; Phase; Policy Maker; Postdoctoral Fellow; Productivity; Race; Regimen; Research; Research Personnel; Research Training; Retrospective cohort; Risk Factors; Role; Stem cell transplant; Time; Training; Treatment Cost; Treatment Protocols; Triplet Multiple Birth; Underserved Population; Urbanicity; access disparities; black patient; cancer health disparity; cancer site; care costs; cost; deprivation; experience; follower of religion Jewish; health data; health plan; indexing; lenalidomide; member; mortality; novel; novel therapeutics; outcome disparities; pandemic disease; peer; pre-pandemic; racial disparity; racial population; residence; skills; social; social health determinants; treatment pattern; underserved community

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.

项目摘要/摘要 在K99/R00杰出早期博士后研究人员独立之路奖中 申请，哈姆雷特·加索扬博士概述了一项详细的建议，以加强他的癌症研究培训 差异研究，同时检查与治疗相关的差异的可修改决定因素 多发性骨髓瘤(MM)患者。加索扬博士的主要目标是成为一名独立和 癌症健康差异领域富有成效的调查者，重点研究与肥胖相关的问题 癌症。他对K99导师培训的短期培训目标是：(1)推进他的 癌症差异研究方面的知识和技能；(2)提高分析电子病历生成的技能 卫生服务研究的临床和大量管理数据；以及(3)获得经验和技能 成功领导研究实验室并与医生、社区成员、 以及医疗保健政策制定者。 MM是美国第二种最常见的血液系统恶性肿瘤，估计有34,920例 2021年将出现12,410个致命后果。黑人患多发性骨髓瘤的几率要高得多，因为 与白人相比，多发性骨髓瘤的死亡率更高，可能是由于几个复杂的风险 因素，如遗传和暴露于已确定的多发性骨髓瘤危险因素的差异，如肥胖。 多发性骨髓瘤的治疗费用很高，是所有癌症部位中终生净成本最高的之一。虽然很新奇 治疗药物和方案可用，新诊断的黑人患者接受干细胞移植的可能性较小 细胞移植，使用处方口服药物来那度胺，或接受三胞胎(3种药物)方案治疗， 如Bortezomib、来那度胺和地塞米松，比他们的White同龄人更好。此外，黑人患者 与他们的白人同行相比，接受这些新疗法的时间要晚一些。考虑到高昂的治疗成本，健康 保险覆盖范围可能在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在MM护理模式中的作用还没有得到很好的研究。 此外，虽然新冠肺炎的流行使得提供面对面的医疗护理变得更加重要 具有挑战性，特别是对来自服务不足社区的个人来说，到目前为止还没有研究调查这种影响 新冠肺炎大流行对MM护理模式差异的影响。 拟议的研究计划的目的是(1)检查 决定因素 患者的保险覆盖范围和社会保障 健康状况可以解释MM治疗模式中的种族差异，(2)评估 新冠肺炎对MM护理模式的影响，以及(3)评估支付者类型和费用分担安排 与使用三联方案诱导治疗MM的不同有关，以及 使用来那度胺等口服处方药进行维持性治疗。