Impact of Health Care Funding on overall Survival of Patients with Multiple Myeloma and Monoclonal Gammopathy of Uncertain Significance.

The impact of socioeconomic status on patients with cancer has been previously reported. Health care funding improves access to care and thus outcome. There is little information on the impact of health care funding on hematological malignancies including multiple myeloma.

To analyze the effect of health care funding on the survival of patients with multiple myeloma (MM) and monoclonal gammopathy of uncertain significance (MGUS) in North Louisiana. A retrospective study of all patients diagnosed with multiple myeloma/MGUS and treated at Louisiana State University Health Science Center in Shreveport, LA between the years 1997 and 2010 was completed.

Electronic medical records from our hospital and Social Security Death Index were used to identify patients and to define patient characteristics, demographic factors, medical funding source and date of death. Medical funding was defined as being funded (Medicaid, Medicare or private insurance) or non-funded (free care or self pay). Descriptive statistics, Product-Limit methods were used to estimate survival and Log rank test was used to compare the survival difference for each factor.

257 patients were reviewed, of which 208 had multiple myeloma and 49 had MGUS. Median age of patients with MGUS and MM was 59 years and 60 years respectively (range 30–93).There were 92 (37%) Caucasians and 165 (63%) African Americans, 114 (44%) male and 143 (56%) female patients, and 177 (69%) were funded and 80 (31%) were non-funded. Of the patients with MM, 49 (23.5%) were stage 1, 23 (11%) were stage 2, 95 (45.6%) were stage 3A and 41 (19.7%) were stage 3B disease. The 5-year survival for MM was 60% and 42% for funded and non-funded patients respectively (p=0.03). The 5-year survival for MGUS was 95% and 62% for funded and non-funded patients respectively (p=0.012). Funded patients with MM had an overall survival of 6.2 years while it was 3.8 years for the non-funded (p=0.012). The survival difference relative to race and sex was not statistically significant.

Our analysis demonstrates that patients with multiple myeloma and MGUS with funding have statistically significant increased overall survival compared to patients with no funding. Presumably patients with funding have better access to medical care, which would allow for earlier diagnosis, more effective therapy of smaller tumor burden and access to all therapeutic options. Lead time bias could contribute to some of the improved survival but is doubtful. To our knowledge, this is the first study to explore the impact of health funding on the survival of patients with multiple myeloma and MGUS, however validation with a larger prospective study is needed.

No relevant conflicts of interest to declare.