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Regional differences in treatment and outcome for myeloma patients in Sweden : A population based Swedish myeloma register study

Wålinder, Göran ; Genell, Anna ; Juliusson, Gunnar LU ; Svensson, Ronald ; Santamaria, Antonio Izarra ; Crafoord, Jacob ; Carlson, Kristina ; Knut-Bojanowska, Dorota ; Veskovski, Ljupco and Lauri, Birgitta , et al. (2022) In Cancer Reports 5(11).
Abstract

Background: We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. Aim: To study differences in survival for MM depending on health care region and early use of modern treatment. Methods and results: Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A–F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6 months after diagnosis. In all treated MM patients (n = 5326), we observed a superior overall survival (OS) for region A compared to all... (More)

Background: We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. Aim: To study differences in survival for MM depending on health care region and early use of modern treatment. Methods and results: Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A–F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6 months after diagnosis. In all treated MM patients (n = 5326), we observed a superior overall survival (OS) for region A compared to all other regions (p <.01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (p <.01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75 years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank p =.04, HR 1.2, CI 1.00–1.44, p =.06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (p =.01, p <.01, p <.01, p =.03). Conclusion: We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75 years or older, differences in survival could be adjusted for.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cancer care, epidemiology, multiple myeloma, treatment outcome
in
Cancer Reports
volume
5
issue
11
article number
e1614
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85125534552
  • pmid:35243814
ISSN
2573-8348
DOI
10.1002/cnr2.1614
language
English
LU publication?
yes
id
ce196a21-b30d-47a0-be30-15c372d79c61
date added to LUP
2022-04-19 15:00:17
date last changed
2024-02-20 14:42:28
@article{ce196a21-b30d-47a0-be30-15c372d79c61,
  abstract     = {{<p>Background: We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. Aim: To study differences in survival for MM depending on health care region and early use of modern treatment. Methods and results: Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A–F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6 months after diagnosis. In all treated MM patients (n = 5326), we observed a superior overall survival (OS) for region A compared to all other regions (p &lt;.01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (p &lt;.01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75 years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank p =.04, HR 1.2, CI 1.00–1.44, p =.06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (p =.01, p &lt;.01, p &lt;.01, p =.03). Conclusion: We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75 years or older, differences in survival could be adjusted for.</p>}},
  author       = {{Wålinder, Göran and Genell, Anna and Juliusson, Gunnar and Svensson, Ronald and Santamaria, Antonio Izarra and Crafoord, Jacob and Carlson, Kristina and Knut-Bojanowska, Dorota and Veskovski, Ljupco and Lauri, Birgitta and Lund, Johan and Turesson, Ingemar and Hansson, Markus and Blimark, Cecilie Hveding and Nahi, Hareth}},
  issn         = {{2573-8348}},
  keywords     = {{cancer care; epidemiology; multiple myeloma; treatment outcome}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Cancer Reports}},
  title        = {{Regional differences in treatment and outcome for myeloma patients in Sweden : A population based Swedish myeloma register study}},
  url          = {{http://dx.doi.org/10.1002/cnr2.1614}},
  doi          = {{10.1002/cnr2.1614}},
  volume       = {{5}},
  year         = {{2022}},
}