Avaliação da associação do status socioeconômico com as características clínicas e demográficas ao diagnóstico dos pacientes com mieloma múltiplo

Abstract

Multiple lívia coelhomyeloma (MM) is a hematological neoplasm that results from the clonal proliferation of plasma cells in the bone marrow, with a heterogeneous clinical presentation, with anemia, hypercalcemia, renal dysfunction and bone damage being common. The association between socioeconomic status and cancer-related outcomes has already been studied by several authors. Analyzes on solid and hematological neoplasms reveal that staging, treatment and prognosis are impacted by socioeconomic inequalities. This occurs because living conditions affect access to the health system, time to diagnosis, adherence to treatment, among other factors, which is therefore related to cancer mortality/survival. Information regarding MM in Brazil, focusing on patient’s socioeconomic characteristics, is scarce. Objectives: To analyze the association of socioeconomic conditions with clinical and demographic characteristics at presentation and treatment data and outcomes of patients with MM from three institutions in Rio de Janeiro, in addition to describing the clinical, sociodemographic, therapeutic aspects and outcomes and evaluating the applicability of socioeconomic measurement instruments. Methodology: This is a retrospective study with collection of data from patients diagnosed with MM between January 2015 and February 2023, in the Hematology services of Pedro Ernesto University Hospital, Galeão Air Force Hospital and Oncology D'Or Institute, and with application of the CCEB - 2021 socioeconomic questionnaire to patients or family members (in case of the patient's death). For socioeconomic assessment, information about education level was also collected and per capita income was estimated according to each individual's place of residence. Results: 296 patients were included, with most of the sample being women and with a median age at diagnosis of 65,6 years. The majority had complaints related to end organ damage, worse performance status and Durie Salmon stage III. The median times for diagnosis and initiation of treatment were 4,7 months and 24 days, respectively. Eighteen patients died before the start of chemotherapy, and autologous bone marrow transplantation was performed in 120 individuals. There were 139 cases of death, and the main causes were disease and infection. An association was found between lower social class, lower level of education and/or lower income with longer time to diagnosis, advanced Durie Salmon stage, worse performance status, lower hemoglobin levels, higher calcium and more symptoms at diagnosis. Furthermore, it was also observed, in patients with worse socioeconomic status, a lower use of more modern and effective medicines, a longer time to perform the bone marrow transplant, less post-transplant maintenance treatment and higher rates of early mortality, up to three months after diagnosis. Conclusion: These findings confirm a subjective expectation of professionals involved in the care of patients with MM, with real data from care in Brazil, and should be considered in the formulation of health policies for the early diagnosis of hematological neoplasms and broader access to the most modern therapies, which will certainly lead to better therapeutic outcomes.