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.

项目概要/摘要 K99/R00 杰出早期博士后研究人员独立之路奖 在申请中，哈姆雷特·加索扬 (Hamlet Gasoyan) 博士概述了加强癌症研究培训的详细建议 差异研究与检查与治疗相关的差异的可改变的决定因素相结合 多发性骨髓瘤（MM）患者。 Gasoyan 博士的首要目标是成为一名独立且 癌症健康差异领域富有成效的研究者，研究重点是与肥胖相关的 癌症。他参加 K99 指导培训的短期培训目标是 (1) 提高他的能力 癌症差异研究的知识和技能； (2) 提高分析 EHR 生成的技能 用于卫生服务研究的临床和大型管理数据； (3) 获得经验和技能 需要成功领导一个研究实验室并与医生、社区成员合作， 和医疗保健政策制定者。 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 例致命结果。黑人的 MM 发病率要高得多，因为 与白人相比，多发性骨髓瘤死亡率更高，可能是由于多种复杂的风险 因素，例如遗传因素和暴露于已确定的多发性骨髓瘤危险因素（例如肥胖）的差异。 多发性骨髓瘤的治疗费用昂贵，是所有癌症部位中终身净成本最高的疾病之一。虽然小说 有可用的治疗药物和方案，新诊断的黑人患者接受干细胞治疗的可能性较小 细胞移植、使用处方口服药物来那度胺或接受三联（3 种药物）方案治疗， 比白人同龄人更喜欢硼替佐米、来那度胺和地塞米松。此外，黑人患者 与白人同龄人相比，他们接受这些新疗法的时间较晚。由于治疗费用高昂，健康 保险范围可能在获得多发性骨髓瘤新疗法的种族差异中发挥着重要作用。 然而，未保险或保险不足在 MM 护理模式中的作用尚未得到充分研究。 此外，虽然 COVID-19 大流行使得现场医疗护理变得更加重要 具有挑战性，特别是对于来自服务不足社区的个人来说，迄今为止还没有研究调查其影响 COVID-19 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）检查是否 决定因素 患者的保险范围和社会保障 健康状况可以解释 MM 治疗模式中的种族差异，(2) 评估 COVID-19 大流行对 MM 护理模式的影响，以及 (3) 评估付款人类型和费用分摊安排是否 与三联方案诱导治疗 MM 的使用差异相关 使用处方口服药物维持治疗，例如来那度胺。