Blood cancers

Benefits from bortezomib not available to all

Socioeconomic deprivation is stalling improvements in outcomes for multiple myeloma patients in New Zealand, especially those from Maori and Pacific Island backgrounds.

An analysis of cases from the New Zealand Cancer Registry between January 2004 and December 2016 confirmed the incidence of multiple myeloma is increasing.

The age-standardized incidence rate (ASIR) increased from 4.01 per 100,000 in 2004 to 5.28 per 100,000 in 2016.

Differences in ASIR were noted between ethnic groups, with Pacific Islanders having the highest rate at 10.1 per 100,000 and Asians having the lowest rate at 3.5 per 100,000.

The proportions of Maori and Pacific Islanders with myeloma were substantially higher at higher levels of socioeconomic deprivation (37% of registrants in deciles 9/10 compared with 5% in deciles 1/2).

The study, published in the British Journal of Hematology, also found overall survival increased over the study period and particularly in the period since public funding of bortezomib in 2011.

Median OS improved from 38.1 months pre-bortezomib to 50.7 months for those diagnosed in the bortezomib era.

However the benefits of new anti-myeloma treatments have not flowed through to all patients, despite New Zealand’s relatively universal access to medicines.

“The most deprived groups (deciles 9/10) had an inferior 3-year OS compared to others (0.57 vs. 0.63; P = 0.026) and experienced no improvement in survival following the funding of bortezomib, despite similar uptake of first line bortezomib (50% of patients within 14 days of registration; 95% CI 46%, 51%; P = 0.57) and mean cumulative dosage (65.5 mg vs. 71.4 mg; P = 0.75),” the study said.

The study added that the variation in survival between ethnic groups was primarily driven by differences in socioeconomic deprivation.

Dr Henry Chan, consultant haematologist with the Waitematā District Health Board and the University of Auckland, told the limbic that there were simple strategies to help patients access the benefits of therapy.

He said issues such as turning up to appointments could be resolved with some forethought.

“For example, bortezomib is usually given as a weekly injection. There are people working on, for example, to have the bortezomib given at home where we send a district nurse to go to someone’s house or patients take the extra supply and do it themselves rather than coming all the way into hospital.”

He said such strategies could be relatively cheap compared to the costs of the medicine.

“These drugs are available and they are changing patients’ outcomes but at the same time, from a systems point of view, we do need to do some simple things to make it more accessible to patients.”

“If the government has the intention of giving this drug and improving outcomes for the population, then I think it is also important to make sure everyone has equal access to the drugs – not just making it free and allowing clinicians to prescribe it – but doing whatever is possible to remove barriers to access.”

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