Source: Myeloma – Hematology Advisor
Among older adults with multiple myeloma (MM) receiving home health services, functional disability is a predictor of early mortality, according to research published in JCO Clinical Cancer Informatics.
“The care of patients with MM is often challenging because of the higher prevalence of vulnerabilities observed with advancing age, a risk factor associated with MM incidence,” the authors wrote in their report.
The researchers retrospectively evaluated the relationships between disability, treatment receipt, and survival outcomes in older adults with newly diagnosed MM using the US nationwide Surveillance, Epidemiology, and End Results (SEER)-Medicare data set.
The study included adults aged ≥66 years diagnosed with MM from 2010 to 2017 who used home health services the year before diagnosis. At home health assessment, patients’ degree of functional disability was assessed using a composite score derived from items related to ability to complete activities of daily living. The primary outcome was overall mortality, and secondary outcomes included receipt of any MM therapy in the year after diagnosis, treatment type, and health care utilization.
A total of 37,280 adults aged ≥66 years were diagnosed with MM from 2010 to 2017. Of those, 18.2% used home health services in the year before diagnosis. Those who used home health services were categorized as having mild disability (34.5%), moderate disability (32.1%), and severe disability (33.3%).
Patients with moderate disability at assessment had similar receipt of MM-directed therapy as those with mild disability and similar health care usage after diagnosis as patients with severe disability.
Patients who used home health services had a higher comorbidity burden (3 vs 2) and higher mortality (adjusted risk ratio [RR] for 3-year mortality, 1.59; 95% CI, 1.55-1.64) than those who did not use these services. Postdiagnosis mortality was higher among those with more severe functional disability before diagnosis (adjusted RR at 6-months: severe vs mild, 2.30; 95% CI, 2.05-2.58; moderate vs mild, 1.32; 95% CI, 1.22-1.43).
“These individuals [requiring home health services] have greater early mortality than older adults with MM who did not previously receive [home health] services, potentially highlighting the utility of [home health] service receipt as a marker of individuals who will need more intensive support when starting therapy,” the authors wrote.
Limitations of the study included its retrospective nature, lack of distinction between individuals with clinically overt MM and those with presymptomatic smoldering MM, and assessment of newly diagnosed patients potentially receiving first-line therapy.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.