Demographics and Mortality of Patients Diagnosed with Multiple Myeloma Treated in the US Community Oncology Setting from 2018 to 2023: Assessing Trends in the Pre-, Peri- and Post-Pandemic Eras

Background: Multiple myeloma (MM) is a disease predominantly of older age, but also with disproportionate incidence in the Black population. Furthermore, we increasingly recognize the potential impact of disparities in access to care on health outcomes, in particular during the COVID-19 pandemic and now its aftermath. Open questions remain regarding the extent to which disparities were exacerbated by the pandemic, and whether pandemic-associated gaps in care are resolving. Given the unique nature of MM as a chronic disease requiring extended therapies over time, the purpose of this study was to describe recent demographic trends, especially for age and race, in patients diagnosed with MM and their mortality outcomes in a US community oncology setting in the periods of time surrounding the pandemic.

Methods: This was a retrospective observational study using structured electronic health records data from within The US Oncology Network and selected non-Network practices, which covers a nationally representative network of over 2,700 providers and more than 1 million patients seen annually in community-based oncology practices. All patients with a new diagnosis of or first visit for MM from 1/1/2018 to 12/31/2023 were included. The index date was the date of diagnosis or first visit. Patient demographics as well as the proportion of patients surviving 1 and 2 years following index were descriptively summarized overall and by index year.

Results: A total of 13,138 patients were identified. The majority of patients (56%) were male; 59% were White, 15% were Black, 7% were of other race, and 19% were missing race information. Mean (standard deviation [SD]) age at index was 69 (11) years. An 8% drop year-over-year in new patients was observed from 2019 to 2020 at the advent of the pandemic (2,189 vs. 2,010). The number of patients increased again in subsequent years (2,166 in 2021 and 2,554 in 2022) and decreased to pre-pandemic levels in 2023 (2,164). Among patients with a documented race, the proportion of White patients reduced in later years (68% in 2023 compared to 74% in 2018), while the proportion of patients with other races increased (from 7% to 13%). Fewer Black patients were diagnosed in 2021 compared to the beginning and end of the study period (16% vs. 18% in 2018 and 19% in 2023). While in 2018, 50% of the population was aged ≥70 at index, this proportion was lowest in 2020 (48%) and increased to 55% by 2023. Across the entire study period, mean (SD) age at index increased marginally (69 [11] in 2018 and 70 [11] in 2023). The number of patients who died within 1 year of index was highest during the first pandemic year (13% in 2020), but gradually declined in subsequent years, back to pre-pandemic levels (10% of 2022 patients, 11% of 2018 patients). A similar pattern was observed for the proportion of patients who died within 2 years of index (19% in 2018, 22% in 2020, and 20% in 2021).

Conclusions: In the 5-year period from 2018-2023 that was inclusive of the COVID-19 pandemic, in a real-world US community setting, we observed a decrease in new MM patients, particularly Black patients and those aged ≥70 years, in the peak of the pandemic, with subsequent recovery. There was also a higher mortality of new MM patients in the peak year of the pandemic. These observations are consistent with a negative impact of the pandemic on timely access to care for diagnosis and management, with potential adverse outcomes, particularly for MM as a chronic disease requiring concerted management and follow-up. However, data suggest that pandemic-related gaps in care may be resolving, and the demographics of MM patients are changing. Over the study period as a whole, there was an overall increase in the proportion of older patients and non-White patients. While encouraging to observe recovery of health care delivery post-pandemic for MM patients, we must remain cautious and focused on the lessons in understanding ongoing disparities to inform solutions to optimize the lives of MM patients.

Herms:Ontada, part of McKesson: Current Employment, Current equity holder in publicly-traded company. Su:Ontada, part of McKesson: Current Employment. Paulus:Ontada, part of McKesson: Current Employment. Zackon:Cardinal Health: Other: My wife is a CMO. ; Ontada, part of McKesson: Current Employment.