Cancer Res Treat.  2020 Jan;52(1):1-9. 10.4143/crt.2018.702.

The Effect of Disability on the Diagnosis and Treatment of Multiple Myeloma in Korea: A National Cohort Study

• Kwon J
• Kim SY
• Yeob KE
• Han HS
• Lee KH
• Shin DW
• Kim YY
• Park JH
• Park JH

• KMID: 2501196
• DOI: http://doi.org/10.4143/crt.2018.702

Abstract

Purpose
This study aimed to determine whether the diagnosis, treatment approach, and prognosis of multiple myeloma (MM) vary according to the presence and type of disability.
Materials and Methods
Demographic, socioeconomic, and medical data were obtained from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database. An age- and sex-matched cohort was established using a 1:3 ratio constituted with 2,776,450 people with disabilities and 8,329,350 people without disabilities. Adult patients diagnosed with MM were subsequently selected from this cohort. Disabilities were categorized as physical, communication, intellectual or psychological, and affecting the major internal organs.
Results
The cohort included 4,090 patients with MM, with a significantly lower rate per 100,000 persons among people with disabilities than among people without disabilities (29.1 vs. 39.4, p < 0.001). People with disabilities were more likely to undergo dialysis treatment at the time of diagnosis (16.3% vs. 10.0%, p < 0.001), but were less likely to undergo autologous stem cell transplantation (37.5% vs. 43.7%, p=0.072). This trend was more evident among patients with intellectual or psychological disabilities. The median overall survival among patients with disabilities was significantly shorter than that among patients without disabilities (36.8 months vs. 51.2 months, p < 0.001).
Conclusion
In Korea, people with disabilities generally have a lower rate of MM diagnosis, receive less intensive treatment, and have a lower survival rate than people without disabilities.

Keyword

Disability; Multiple myeloma; Cohort; Survival

Figure

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  Fig. 1. CONSORT diagram. The total number of multiple myeloma (MM) patients who met the inclusion criteria was 4,090. Except the 496 patients who acquired after being diagnosed with MM, the final number of MM patients with disabilities was 809. The number of MM patients without disabilities was 3,281.

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  Fig. 2. Comparison of income level structure with or without disability. A comparison of the economic situation of people without disabilities (red) or with disabilities (blue). People with disabilities have a high percentage of below poverty line.

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  Fig. 3. Overall survival comparison by presence or absence of disability (A), severity of disability (B), type of disability (C).

Reference

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