Zip code can be a risk factor

CHICAGO – Multiple myeloma is a serious and often deadly disease, but outcomes may be better for those whose medical care is covered by private insurers.

Or, it’s possible all survival, like politics, is local, and thus outcome is determined by zip code.

So found Kamal Chamoun, MD, a Fellow with the Hematologic Malignancies and Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Cleveland, and colleagues, who took a deep dive into the National Cancer Database to identify 117,926 people living with multiple myeloma between 2005 and 2014. They then ran those data against a number of factors — age, insurance type, gender, and income by region — to characterize the cohort. Just over half were men (55%) and 57% lived in neighborhoods where the median household income was less than $46,000. More than half were on Medicare, 35% had private insurance, 5% were on Medicaid, and 3% were uninsured.

Chamoun noted that advances in the last 10 years have changed the natural history of multiple myeloma so that more people are surviving, and that change is driven by new treatments that are available in oral formulations — an important distinction, since most of these drugs are expensive and require at the least a hefty copay, which could be a factor for those with limited income.

For example, when he and his colleagues analyzed the outcomes based only on insurance, Medicare recipients had a significantly worse survival than those with private insurance, but that difference disappeared when other factors such as age and co-morbidities were factored into the analysis.

Nonetheless, copays are a barrier for Medicare patients, said ASCO spokesperson Catherine Diefenbach, MD, of NYU’s Langone Medical Center, who cited an example from her own practice. “Prices of oral medications have soared over last 5 years and higher costs means more challenges with respect to access. In my practice, we had a patient whose medicine would cost $20,000 a month out of pocket. He couldn’t take the drug,” she said, and added: “Our staff worked with him and we were able to get the costs got down to $40 a month, but not all patients have access to that kind of service. … as a society we need to strive to be sure every patient receives equal access.”

Among the study findings:

  • People living in a region where the median income was $46,000 or more had a 16% greater chance of surviving than those in areas with lower incomes.
  • People with private insurance had a 59% greater probability of survival than those who were insured through Medicaid.
  • People with private insurance had a 62% greater probability of survival than those who had no insurance.
  • Medicare eligible patients — those age 65 or older — were more likely to survive if they had private insurance.

Other factors that influenced survival were distance traveled to access care — the closer, the better—and treatment at an academic center rather than community practice, with outcomes favoring academic centers.



Chouman had no disclosures but some of his co-authors disclosed consulting or advisory roles with Celgene, Pfizer and Amgen, Roche, and Kite as well as research funding from Celgene.

Diefenbach disclosed Stock ownership in Gilead Sciences, consulting for Bayer, Bristol-Myers Squibb, Genentech/Roche. Janssen, Merck, Seattle Genetics, and research funding from Bristol-Myers Squibb (Inst), Genentech (Inst), Incyte (Inst), Janssen (Inst), LAM Therapeutics (Inst), MEI Pharma (Inst), Merck (Inst), Millennium (Inst), Roche/Genentech (Inst), and Seattle Genetics (Inst).


Chamoun K, et al “Insurance status and survival of multiple myeloma (MM) patients” ASCO 2019; Abstract LBA107.

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