Understanding the symptom burden and health-related quality of life among Black patients with multiple myeloma: A retrospective analysis of patient-reported data.

Abstract

327 Background: Multiple myeloma (MM) disproportionately affects Black individuals, who have higher incidence and mortality than non-Black populations. Despite advances in treatment, disparities persist, and Black patients remain underrepresented in clinical trials and outcomes research. Prior studies have focused on survival and treatment patterns, with limited attention to patient-reported symptom burden and health-related quality of life (HRQoL). Understanding variation in symptom burden, functional status, and social support is critical to informing targeted supportive and palliative care interventions. Methods: We conducted a retrospective cohort study of 690 adults with MM treated at an academic cancer center in the Southeastern United States (187 Black, 503 non-Black). Participants completed validated patient-reported outcome measures (PRO-CTCAE, PROMIS). Demographic and clinical data were obtained from self-report and electronic health records. Racial differences were assessed using unadjusted and adjusted regression models, with multiple imputation for missing data. Results: The mean age was 67.1 years; 45.5% were female. Compared to non-Black participants, Black participants were less likely to be partnered, had higher comorbidity burden, and were less likely to receive stem cell transplantation (all p<0.05). Most moderate-to-severe symptoms were similar across race after adjustment, except insomnia (OR=1.70, 95% CI: 1.19–2.46, p=0.004) and peripheral neuropathy (OR=1.48, 95% CI: 1.01–2.18, p=0.043), which were higher among non-Black patients. In contrast, significant HRQoL differences were observed. Black participants reported lower physical function (42.8 [9.8] vs 44.6 [9.2], p=0.02), greater pain interference (54.9 [9.8] vs 53.3 [9.2], p=0.04), and lower treatment-related self-efficacy (48.9 [9.2] vs 50.9 [8.6], p=0.008). The largest differences were in social domains, with lower instrumental support (56.5 [7.9] vs 58.5 [7.1], p=0.001) and companionship (52.7 [9.6] vs 56.5 [7.1], p<0.001). Conclusions: Symptom burden was largely comparable across racial groups; however, Black patients experienced meaningful disparities in social support and treatment-related self-efficacy. These findings suggest disparities in MM may be driven more by unmet supportive care needs than by symptom burden alone. Supportive and palliative care interventions that prioritize social support, care navigation, and patient empowerment may help reduce persistent outcome disparities.