Despite significant advances in multiple myeloma treatment over the past two decades, new research reveals persistent and troubling disparities in patient outcomes based on socioeconomic status, geographic location, and comorbidities. Two complementary studies presented at major medical conferences highlight how factors beyond disease biology continue to significantly impact patient survival and quality of life.
Socioeconomic Status Directly Impacts Quality of Life
The GIMEMA-CLARITY study, a longitudinal investigation of patients with relapsed/refractory multiple myeloma, found that socioeconomic inequalities directly correlate with worse health-related quality of life outcomes. Francesco Sparano, MSc, a research associate at the Italian-based GIMEMA Foundation, led the analysis which classified patients into three socioeconomic categories based on education level, employment status, and living arrangements.
"We have found that, overall, patients with a low socioeconomic status also reported a lower quality of life," Sparano explained during his presentation at the 2025 European Hematology Association Congress. The study revealed that patients with low socioeconomic status consistently reported higher prevalence of clinically important problems across all measured symptoms and functional aspects.
The research team calculated the prevalence of clinically important problems and symptoms for each patient, focusing on impairments that limited daily life activities. "This prevalence tended to decrease with the increasing of socioeconomic status for most scales," Sparano noted, demonstrating a clear gradient effect where higher socioeconomic status correlated with better quality of life outcomes.
Income and Geographic Disparities in Mortality Persist
A comprehensive analysis of incidence-based mortality rates from 2000 to 2021, using SEER data from 17 cancer registries, revealed stark disparities in multiple myeloma outcomes based on household income and geographic location. The study found that patients from households earning less than $40,000 annually had an incidence-based mortality rate of 7.3 per 100,000—nearly twice as high as the 5.31 per 100,000 rate observed in households earning over $120,000.
Geographic location also played a significant role in outcomes. People living in non-metropolitan or rural areas experienced higher mortality rates at 6.14 per 100,000 compared with 5.94 per 100,000 in metropolitan areas. Notably, while overall mortality rates declined across all groups during the 21-year study period, the relative gap between lower-income or rural patients and their higher-income, urban counterparts remained stable.
Researchers attributed these persistent disparities to differences in insurance coverage, access to novel therapies, and fewer specialized healthcare resources in underserved communities. Rural patients often face the additional burden of traveling long distances to access oncologists or cancer centers, while low-income individuals may delay care due to high costs or inadequate insurance coverage.
Chronic Kidney Disease Emerges as Critical Comorbidity
A separate retrospective analysis of 267 patients with confirmed multiple myeloma examined how comorbidities impact disease progression and survival outcomes. Among the nine comorbidities assessed—including chronic kidney disease, atrial fibrillation, coronary artery disease, congestive heart failure, diabetes mellitus, COPD, stroke, liver disease, and prior malignancy—chronic kidney disease emerged as a particularly significant risk factor.
Patients with chronic kidney disease demonstrated substantially worse outcomes across multiple measures. They were more likely to have high-risk multiple myeloma (8.4% vs. 1.7%; P = .019), be diagnosed at R-ISS stage III (11.0% vs. 1.4%; P < .001), and experience mortality (12.3% vs. 4.0%; P = .026) compared with those without chronic kidney disease. Additionally, atrial fibrillation was more prevalent among high-risk patients compared with standard-risk patients (15.9% vs. 6.7%; P = .028).
Barriers to Equitable Care Access
The financial challenges faced by multiple myeloma patients extend beyond direct treatment costs. Even in countries with universal healthcare coverage like Italy, patients must often afford out-of-pocket expenses for transportation to specialized centers in other regions and supportive treatments not fully covered by insurance systems.
Researchers emphasized that clinical trials and advanced diagnostics are more commonly available at large academic centers located in metropolitan areas, making them often inaccessible to rural populations. This geographic concentration of specialized care creates additional barriers for patients who may benefit most from novel therapeutic approaches.
Call for Targeted Interventions
The convergence of evidence from these studies underscores that multiple myeloma outcomes are not solely determined by disease biology or available therapies. "These findings call for targeted interventions to reduce these disparities and further research to address the underlying causes, ensuring equitable access to advancements in myeloma care," researchers urged.
The studies highlight how common barriers to care—including income level, geographic location, and clinical complexity related to comorbidities—continue to significantly impact diagnosis, treatment, and patient outcomes. As the population ages and chronic disease burden increases, addressing these disparities becomes increasingly critical for ensuring that advances in multiple myeloma treatment benefit all patients equally.
