Adam Jones1, Stella Bowcock2, Bernard Rachet1. 1. London School of Hygiene and Tropical Medicine, London, UK. 2. Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK.
Abstract
OBJECTIVE: Myeloma is primarily a disease of the elderly, but older patients experience poorer outcomes. Effective treatments may not be offered to older patients over fears about toxicity, particularly for those with comorbidities. We aimed to characterise the trend in survival disparity between older and younger patients and assess to what extent comorbidity might explain these disparities. METHODS: We examined records for 56 010 patients diagnosed with myeloma in England between 1998-2014. The Hospital Episode Statistics database provided information on comorbidity. Net survival was estimated for each diagnosis period. Adjusted excess hazard ratios for the effect of age were estimated using flexible parametric models. RESULTS: Net survival increased for all age groups over the study period. However, older patients experienced a higher risk of death from their disease consistent between 1998 and 2014. Adjusting for comorbidity made little difference to the estimates. CONCLUSION: Factors other than comorbidity must explain the poorer survival experience of elderly patients. Treatment data were not examined and should be employed by future population studies. Inconsistent treatment of elderly patients with myeloma may be prevented by further use of pragmatic clinical trials which are inclusive of older adults, and also wider utilisation of frailty scores.
OBJECTIVE:Myeloma is primarily a disease of the elderly, but older patients experience poorer outcomes. Effective treatments may not be offered to older patients over fears about toxicity, particularly for those with comorbidities. We aimed to characterise the trend in survival disparity between older and younger patients and assess to what extent comorbidity might explain these disparities. METHODS: We examined records for 56 010 patients diagnosed with myeloma in England between 1998-2014. The Hospital Episode Statistics database provided information on comorbidity. Net survival was estimated for each diagnosis period. Adjusted excess hazard ratios for the effect of age were estimated using flexible parametric models. RESULTS: Net survival increased for all age groups over the study period. However, older patients experienced a higher risk of death from their disease consistent between 1998 and 2014. Adjusting for comorbidity made little difference to the estimates. CONCLUSION: Factors other than comorbidity must explain the poorer survival experience of elderly patients. Treatment data were not examined and should be employed by future population studies. Inconsistent treatment of elderly patients with myeloma may be prevented by further use of pragmatic clinical trials which are inclusive of older adults, and also wider utilisation of frailty scores.