Day 0 Blog 1
First up this morning was “Overcoming racial disparities in multiple myeloma outcomes and clinical trials: how we are moving care forward today.” Learn more here.
This very interesting presentation was part of the pre-ASH symposium series for physicians continuing medical education (CME). Presented by Drs. Irene Ghobrial, Craig Emmitt Cole, and Omar Nadeem, they presented numerous studies showing that African Americans (AA) — who are twice as likely to get myeloma — received myeloma care later than non-Hispanic white patients, and the treatment was more often less robust (thalidomide instead of lenalidomide, doublet instead of triplet). Also, they were offered fewer clinical trials and had more barriers to care (financial, distance to academic medical center, time off from work). “Being poor will kill you with this disease” said Dr. Cole. Shocking words.
But let’s focus on the tips to improve this disparity! Dr. Cole, who I’ve heard speak before, is such a good communicator. He says he’s done so many more televisits in recent years, which has helped the patients who don’t live near a major academic center (where outcomes are better). Black people are more likely to have a lower white blood cell (WBC) count due to the Duffy Null phenotype, which then disqualifies them from some clinical trials. Testing for this phenotype can then prove that their WBC is fine, and they’ve been able to join the trial. Another suggestion from the panel is to move laboratory tests to include a myeloma panel. This myeloma panel would include light chains, SPEP, etc. to screen more patients more efficiently for myeloma, thereby catching it earlier.
Another suggestion is to make sure you understand the patient’s family and community structure. Who is/are the decision-makers? An example was given of an indigenous man who had initially agreed to a clinical trial, but then backed out because the tribal elders didn’t approve. Dr. Cole was able to have a meeting with the patient and the elders, who after hearing how the trial was being run and why it was important for the patient, readily agreed.
I’ve been really impressed with the mentoring of medical students of color by senior physicians, as it seems clear that having more physicians who look like the patient will lessen those gaps.