Steinbach Mary, Colson Kathleen, Faiman Beth
Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Dana-Farber Cancer Institute, Boston, Massachusetts.
J Adv Pract Oncol. 2022 Jul;13(Suppl 4):23-30. doi: 10.6004/jadpro.2022.13.5.12. Epub 2022 Jul 28.
The overall care of patients with multiple myeloma can present similar challenges. However, disparities in health care require that providers consider each individual's unique circumstances. Disparities based on ethnic/racial group, religion, socioeconomic status, age, sexual orientation or gender identity, or other characteristics can lead to patients receiving less than optimal care and therefore poorer outcomes. Patients who have received more than two lines of therapy can acquire new genetic changes, accelerated cadence of relapse, and suffer from disease sequelae such as pain from prior or ongoing skeletal fractures, recurrent infections, and progressive decline in organ function. Numerous treatment options remain for patients in their first three relapses. Well-designed clinical trials with newer drugs are preferred. Clinicians should discuss clinical trial options and availability with all patients in spite of disparities that may exist. Patients facing disparities are at risk for suboptimal care and should be closely monitored and provided appropriate resources. Continued attention to disease and organ surveillance are critical throughout the course of the disease.
多发性骨髓瘤患者的整体护理可能会面临类似的挑战。然而，医疗保健方面的差异要求医疗服务提供者考虑每个个体的独特情况。基于种族/民族、宗教、社会经济地位、年龄、性取向或性别认同或其他特征的差异可能导致患者接受的护理达不到最佳水平，从而导致较差的治疗结果。接受过两种以上治疗方案的患者可能会出现新的基因变化、复发频率加快，并遭受疾病后遗症的折磨，如既往或持续的骨骼骨折引起的疼痛、反复感染以及器官功能的逐渐衰退。对于首次复发三次以内的患者，仍有多种治疗选择。首选设计良好的使用新药的临床试验。尽管可能存在差异，临床医生仍应与所有患者讨论临床试验的选择和可用性。面临差异的患者有接受次优护理的风险，应密切监测并提供适当的资源。在疾病的整个过程中，持续关注疾病和器官监测至关重要。
