Many Shades of Disparities in Myeloma Care

Treatment of multiple myeloma (MM) has notably evolved with improved patient outcomes over the past few years. Several new drugs have become available, and large national and international clinical trials have set the stage for evidence-based medicine guidelines for the treatment of patients with MM. Although patient outcomes have undoubtedly improved, data increasingly show that several disparities exist at varying levels of health care and that these disparities make the care of patients heterogenous and potentially result in inferior outcomes. These disparities have been described with regard to patient age, race/ethnicity, rural-urban residence, socioeconomic status, and insurance type, among other factors. Looking at the global picture of MM care, there is substantial variation among different countries, primarily depending on the disparate availability of anti-MM drugs and access to quality health care across the world, limiting the delivery of innovative therapeutic approaches at the individual patient level. The causes of these national and international disparities could be multifactorial, intricate, and difficult to isolate. Yet the ongoing research in this field is encouraging, and there seems to be growing momentum to understand such disparities and their causes. It is hoped that this research will lead to solutions that can be implemented in the near future. This review focuses on certain aspects of disparities in MM care, highlighting disparities among different racial/ethnic subgroups, rural-urban differences in America, and global disparities at an international level.