Background. The interrelation between the worldwide incidence, mortality, and survival of patients with multiple myeloma (MM) and relevant factors such as Health Care Access and Quality (HAQ) index, gross domestic product (GDP), health care expenditures, access to cancer drugs, and patient empowerment has not been addressed before. Material and Methods. Epidemiologic data were obtained from the International Agency for Research on Cancer. The mortality-to-incidence ratio (expressed as 1-MIR) was used as proxy for 5-year survival. Information on health expenditure was obtained from Bloomberg Health-Care Efficacy ranking, the HAQ Index was used as a measure of available health care. For patient empowerment, visits to the Web site of the International Myeloma Foundation were used as proxy. Data on GDP and population per country were assessed from the International Monetary Fund and the United Nations Population Division, respectively. Possible associations were analyzed using Spearman's rank-order correlation. Results. The worldwide incidence of MM is currently 160,000, and mortality is 106,000. Age-standardized myeloma incidence varies between 0.54 and 5.3 per 100,000 and correlates with 1-MIR, patient empowerment, HAQ Index, and access to cancer drugs. The 1-MIR varies between 9% and 64% and is closely related to myeloma incidence, HAQ Index, patient empowerment, access to cancer drugs, and health care expenditures. Conclusion. The global incidence and outcome of MM shows significant disparities, indicating under-recognition and suboptimal treatment in many parts of the globe. Results also highlight the importance of economic resources, access to and quality of health care, and patient education for improving diagnosis and survival of patients with MM. The Oncologist 2020;25:1-8 Implications for Practice: Multiple myeloma accounts for 10% of all hematological malignancies and has moved to the forefront of clinical interest because of the significant advances in medical treatment. Diagnosis depends on laboratory tests, imaging, and professional expertise, particularly in patients without a significant M-component. The present data show a substantial worldwide variation in incidence and mortality, that is mainly due (apart from variations due to ethnicity and lifestyle) to disparities in access to and quality of health care, a parameter strongly related to the economic development of individual countries. Improvement of quality of care and, consequently, in outcome is associated with patient empowerment.

Zojer (2020) Quality of life in patients with relapsed/refractory multiple myeloma during ixazomib-thalidomide-dexamethasone induction and ixazomib maintenance therapy and comparison to the general population

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Background: Sickle cell disease (SCD) is a global health concern. Each year as many as 200,000 infants are born with this disease worldwide. Despite improvements in outcomes over the last few decades, patient life expectancy remains 10 to 30 years shorter than that of the healthy population. A major cause of morbidity among patients with SCD is the occurrence of intense, recurrent, acute, severely painful episodes, known as vaso-occlusive crisis (VOCs). As patients age and SCD progresses, an increased frequency of VOCs and other disease-related complications is correlated with an increased risk of morbidity and mortality. Aims: The aim of the current analysis was to determine whether VOC frequency is associated with a decrease in the health-related quality of life (HRQoL) and associated utility of patients with SCD. Methods: LEGACY was a prospective, multicenter, observational study that documented the outcomes of 181 adult patients with SCD living in the United States. Patients were assessed at baseline and every six months for 3 years, on several health outcomes, including the number of VOCs experienced and patient health as assessed by the Short Form-36 (SF-36) Health Survey. For the cohort of patients aged 18 years and older, the total number of VOCs experienced over the previous 12 months was determined for each administration of the SF-36. Patients were categorized into three groups: -0 VOCs in the previous 12 months -1 to 2 VOCs in the previous 12 months -3 or more (3+) VOCs in the previous 12 months The SF-36 scores for individual questionnaires were then mapped to the EuroQoL five-dimension (EQ-5D) questionnaire, which is a standardized instrument that can be used to derive a single utility value. The mapping was done using the random effects GLS mapping algorithm published by Rowan and colleagues (2009). Mean EQ-5D scores were compared between groups using the Student's T-test. Differences between the groups on the SF-36 component scores and SF-36 domains were also assessed. Results: Patients with 3+ VOC events in the previous 12 months had mapped mean EQ-5D scores that tended to be lower (15%) than those of patients who had no VOC events (see Figure 1). Patients who had 3+ VOC events also showed decreases in both SF-36 Physical Component Scores and Mental Component Scores compared to patients with no VOC events. Summary/Conclusion:To our knowledge, this is the first analysis to examine the relationship between VOC frequency and HRQoL in patients with SCD. The results of this analysis indicate that patients who have a higher number of VOC events experience a worse HRQoL compared to patients with no events.