Lu Rebecca, Tariman Joseph D, Catamero Donna, Hillengass Michaela, Noonan Kimberly
From The University of Texas MD Anderson Cancer Center, Houston, Texas.
Rutgers University, Camden, New Jersey.
J Adv Pract Oncol. 2024 Jul 22:1-14. doi: 10.6004/jadpro.2024.15.8.10.
Although advancements in multiple myeloma therapy have rapidly evolved, pervasive racial and social inequities prevent uniform benefit across diverse patient populations. This affects access to US Food and Drug Administration-approved treatments and to clinical studies. The impact of health-care inequities is not well understood and thus, the development of effective strategies is inadequate. We identify different disparities including race, age, socioeconomic status, and sexual preference/orientation and their effect on patient care. We explore recommendations for the advanced practitioner to overcome underrepresentation and increase access in myeloma care.
We performed a literature review using online databases including PubMed and CINAHL to identify different disparities, barriers to clinical studies, and recommendations to improve access. The following terms were used to identify the most relevant articles: myeloma, bias, diversity, racial disparity, inequity, socioeconomic factors, trial, elderly, sexual orientation, and sexual preference.
Racial and socioeconomic inequities largely affect the survival and quality of care available to underrepresented populations as well as elderly patients. Existing inequities negatively affect study enrollment leading to real world consequences. Structural, clinical, and attitudinal factors further compound the issue of equitable trial engagement. Current recommendations for the advanced practitioner include addressing systemic issues to increase understanding of inequities to mitigate socioeconomic factors that deter equitable access.
Understanding the issue of inequities is vital in ensuring myeloma patients are provided appropriate care. Recommendations are rooted in education and improving treatment access. Illuminating the issues of treatment disparities can remove barriers to ensure a more equitable future.
尽管多发性骨髓瘤治疗进展迅速，但普遍存在的种族和社会不平等现象使得不同患者群体无法均等地受益。这影响了获得美国食品药品监督管理局批准治疗的机会以及参与临床研究的机会。医疗保健不平等的影响尚未得到充分理解，因此，有效策略的制定也不够充分。我们确定了包括种族、年龄、社会经济地位以及性取向等不同方面的差异及其对患者护理的影响。我们探讨了针对高级从业者的建议，以克服代表性不足的问题并增加骨髓瘤护理的可及性。
我们使用包括PubMed和CINAHL在内的在线数据库进行文献综述，以确定不同的差异、临床研究的障碍以及改善可及性的建议。以下术语用于确定最相关的文章：骨髓瘤、偏见、多样性、种族差异、不平等、社会经济因素、试验、老年人、性取向和性偏好。
种族和社会经济不平等在很大程度上影响了代表性不足人群以及老年患者的生存和可获得的护理质量。现有的不平等对研究入组产生负面影响，导致实际后果。结构、临床和态度因素进一步加剧了公平参与试验的问题。针对高级从业者的当前建议包括解决系统性问题，以增加对不平等的认识，减轻阻碍公平获取的社会经济因素。
了解不平等问题对于确保骨髓瘤患者获得适当护理至关重要。建议基于教育和改善治疗可及性。阐明治疗差异问题可以消除障碍，以确保更公平的未来。
