Race and income may determine blood cancer outcomes, studies show
By Ernie Mundell
health day reporter
MONDAY, Dec. 12, 2022 (HealthDay News) — If someone has blood cancer or a life-threatening clot, they’re likely to be better off if they’re white and wealthy, according to three new studies.
The ongoing impact of patient race and income on medical outcomes was in the spotlight Saturday in New Orleans at the annual meeting of the American Society of Hematology (ASH).
In one study, a team led by Dr. Matthew Maurer, from the Mayo Clinic in Rochester, Minnesota, examined who had enrolled (or had not) in clinical trials for new treatments for a blood cancer known as the name diffuse wide B-cell lymphoma (DLBCL).
It is the most common form of lymphoma in the United States. According to the ASH, existing therapies help cure about 60% of patients, but an additional 40% may not be helped.
Thus, enrollment in clinical trials may be crucial for some patients. The Mayo Study examined DLBCL trial enrollment data from eight major academic medical centers across America.
He revealed that 76% of the registrants were white.
Lab test results were essential for being accepted into the trials, but black or Hispanic Americans were much less likely to meet those lab criteria than whites, the research showed.
This means that trial organizers may need to take a closer look at laboratory eligibility criteria to help level the playing field for entry into future clinical trials. “These exclusion criteria do not affect everyone equally – they affect minorities more than non-Hispanic white patients,” Maurer said in an ASH press release.
Disparities in stem cell transplantation
Another study looked at stem cell transplants, which in many cases can cure blood cancer. The procedures require finding a donor (often a family member) with the same blood antigenic proteins as the patient.
If such a donor cannot be found, doctors can still perform the transplant, but it often uses “half-matched” cells and comes either from umbilical cord blood or from family members or other people less only ideally compatible. These transplants leave patients more vulnerable to dangerous immune reactions and require more intensive follow-up care.
The study was led by Dr. Warren Fingrut of the Cord Blood Transplant Program at Memorial Sloan Kettering Cancer Center in New York. Reviewing the records of 372 people who underwent stem cell transplants at the center between 2020 and 2022, his team found that while only about a quarter (24%) of patients of European (usually white) ancestry had to undergo the least well-matched form of graft, this number increased to 58% in patients who were not of European descent.
The likelihood that a more complex stem cell transplant would be needed increased even more if the minority patient also came from a low-income household, the investigators found.
“Our transplant program is very committed to expanding access to transplants to minority populations, but our study highlights that many of these patients both receive the most complex transplants and face significant socioeconomic challenges,” said Fingrut said in the ASH press release. “Our results show that overcoming financial hardship will be key to expanding access to transplant, especially to patients from minority groups.”
Advanced treatments for a dangerous clot
In a third study, researchers found that race and income appeared to matter when American patients were affected by life-threatening lung clots called pulmonary embolisms.
Non-white and poorer patients were “significantly less likely to receive the most advanced therapies and more likely to die after suffering a pulmonary embolism,” the ASH press release notes.
The study looked at data from more than one million U.S. patients hospitalized with a dangerous clot in their lungs between 2016 and 2018. More than 66,000 had the most severe and life-threatening form of pulmonary embolism.
Compared to white patients, Asian patients were 24% less likely to receive advanced therapies when affected by a severe form of pulmonary embolism, and they were 50% more likely to die, reported a team led by Dr. Mary Cushman, of Larner College. of medicine at the University of Vermont.
Similarly, black patients in the same situation were 13% less likely to get the best treatments than white patients and 11% more likely to die. Hispanic patients were also 10% more likely to die from their embolism than whites, the investigators found.
Money and insurance mattered too: People insured through Medicaid or Medicare were 30% less likely to receive advanced therapy compared to privately insured people, the study found. And people who were in the bottom quarter by income were 9% more likely to die from their clot than people in the top quarter by income.
“Many people die from pulmonary embolism each year,” Cushman noted in the ASH press release. “It’s preventable and it’s certainly treatable. We need to think about what we can do in hospitals to make sure care is equitable. »
“I hope clinicians will think about these findings in terms of daily patient care and do their best to acknowledge their unconscious biases,” she added. “Clinicians need to look at the patient in front of them and remember that regardless of their social class or skin color, they should be treated the same as everyone else.”
Experts note that studies presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Learn more about blood cancers at the American Cancer Society.
SOURCE: American Society of Hematology, press release, December 10, 2022