Ernie Mundell
Health Day Reporter
MONDAY, Dec. 12, 2022 (HealthDay News) — If someone has blood cancer or a life-threatening blood clot, they may be better off if they are white and wealthy, three new studies suggest.
The continuing influence of patient race and income on medical outcomes was in the spotlight Saturday at the American Society of Hematology (ASH) annual meeting in New Orleans.
In one study, a team led by Dr. Matthew Maurer of the Mayo Clinic in Rochester, Minnesota, looked at who participated (or did not participate) in a treatment for diffuse large B-blood cancer. Clinical Trial of a New Therapy for Cell Lymphoma (DLBCL).
It is the most common form of lymphoma in the United States. According to ASH, existing therapies can help cure about 60 percent of patients, but may not help in another 40 percent.
Therefore, participation in a clinical trial is crucial for some patients. The Mayo study examined registry data for DLBCL trials at eight large academic medical centers in the United States.
It found that 76 percent of enrollees were white.
Research shows that lab test results are key to being accepted into trials, but blacks or Hispanics are less likely than whites to meet these lab-based criteria.
That means trial organizers may need to take a closer look at lab-based eligibility criteria to help level the playing field for entry into future clinical trials. “These exclusion criteria don’t affect everyone equally — they affect minorities more than non-Hispanic white patients,” Maurer said in an ASH news release.
Stem Cell Transplant Differences
Another study looked at stem cell transplants, which in many cases can cure blood cancers. The procedure requires finding a donor (usually a family member) who has the same blood antigen protein as the patient.
If such a donor can’t be found, doctors can still perform a transplant, but it usually uses “half-matched” cells, which come either from cord blood or from family members or other people who are a less-than-ideal match. These transplants leave patients more vulnerable to dangerous immune responses and require more rigorous follow-up care.
The study was led by Dr. Warren Fingrut of the Cord Blood Transplant Program at Memorial Sloan Kettering Cancer Center in New York City. Looking at the records of 372 people who received stem cell transplants at the center between 2020 and 2022, his team found that while only about a quarter (24 percent) of patients of European (usually white) ancestry had to receive less-matched Among patients of non-European ancestry, this figure rose to 58 percent.
The researchers found that minority patients were more likely to need a more complex stem cell transplant if they also came from low-income families.
“Our transplant program is very committed to expanding transplant opportunities to minority populations, but our study highlights that many of these patients both receive the most complex transplant procedures and face significant socioeconomic challenges,” Finrut said in a statement ASH news release said. “Our findings suggest that addressing financial hardship is critical to expanding transplant opportunities, especially for minority patients.”
Advanced Treatment for Dangerous Blood Clots
In a third study, researchers found that race and income appeared to matter when U.S. patients were hit by a potentially life-threatening blood clot in the lung called a pulmonary embolism.
Non-white and poorer patients were “much less likely to receive the most advanced therapies and more likely to die from a pulmonary embolism,” the ASH news release noted.
The study involved data from more than 1 million U.S. patients hospitalized with dangerous blood clots in the lungs between 2016 and 2018. More than 66,000 people suffer from the most severe, life-threatening form of pulmonary embolism.
Compared with white patients, Asian patients were 24 percent less likely to receive advanced treatment when they suffered a severe pulmonary embolism, and they were 50 percent more likely to die, a team led by Dr. Mary Cushman of Laner College reported at the University of Vermont Medical PhD.
Likewise, black patients in the same situation were 13 percent less likely to receive optimal treatment and 11 percent more likely to die than white patients. Hispanic patients were also 10 percent more likely than whites to die from an embolism, the researchers found.
Money and insurance matter, too: Studies have found that people who are insured through Medicaid or Medicare are 30 percent less likely to receive advanced treatment than those who are privately insured. Those in the lowest income quartile were 9 percent more likely to die from blood clots than those in the highest income quartile.
“Many people die from pulmonary embolism every year,” Cushman said in an ASH news release. “It’s preventable and certainly treatable. We need to think about what we can do in hospitals to ensure equity in care delivery.”
“My hope is that clinicians will think about these findings in terms of how they care for patients every day, and do their best to recognize their unconscious biases,” she added. “Clinicians need to look at the patient in front of them and remember that they deserve to be treated like everyone else, regardless of their social class or the color of their skin.”
Experts note that research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
More information
Learn more about blood cancers at the American Cancer Society.
Source: American Society of Hematology, Press Release, December 10, 2022
