Abstract
Background: Although advancements in multiple myeloma therapy have rapidly evolved, pervasive racial and social inequities prevent uniform benefit across diverse patient populations. This affects access to US Food and Drug Administration–approved treatments and to clinical studies. The impact of health-care inequities is not well understood and thus, the development of effective strategies is inadequate. We identify different disparities including race, age, socioeconomic status, and sexual preference/orientation and their effect on patient care. We explore recommendations for the advanced practitioner to overcome underrepresentation and increase access in myeloma care. Method: We performed a literature review using online databases including PubMed and CINAHL to identify different disparities, barriers to clinical studies, and recommendations to improve access. The following terms were used to identify the most relevant articles: myeloma, bias, diversity, racial disparity, inequity, socioeconomic factors, trial, elderly, sexual orientation, and sexual preference. Findings: Racial and socioeconomic inequities largely affect the survival and quality of care available to underrepresented populations as well as elderly patients. Existing inequities negatively affect study enrollment leading to real world consequences. Structural, clinical, and attitudinal factors further compound the issue of equitable trial engagement. Current recommendations for the advanced practitioner include addressing systemic issues to increase understanding of inequities to mitigate socioeconomic factors that deter equitable access. Conclusion: Understanding the issue of inequities is vital in ensuring myeloma patients are provided appropriate care. Recommendations are rooted in education and improving treatment access. Illuminating the issues of treatment disparities can remove barriers to ensure a more equitable future.
References
Aapro, M. S., Köhne, C.-H., Cohen, H. J., & Extermann, M. (2005). Never too old? Age should not be a barrier to enrollment in cancer clinical trials. The Oncologist, 10(3), 198–204. https://doi.org/10.1634/theoncologist.10-3-198
Adams, K., Guerrieri, L., & Tariman, J. (2018). Systematic review: Diversity of enrollment in multiple myeloma drug trials among different ethnicities. Grace Peterson Nursing Research Colloquium. 26. https://via.library.depaul.edu/nursing-colloquium/2018/winter/26
Ailawadhi, S., Aldoss, I. T., Yang, D., Razavi, P., Cozen, W., Sher, T., & Chanan-Khan, A. (2012). Outcome inequities in multiple myeloma: A SEER-based comparative analysis of ethnic subgroups. British Journal of Haematology, 158(1), 91–98.
Ailawadhi, S., Jacobus, S., Sexton, R., Stewart, A. K., Dispenzieri, A., Hussein, M. A.,…Rajkumar, S. V. (2018). Disease and outcome inequities in multiple myeloma: Exploring the role of race/ethnicity in the Cooperative Group Clinical Trials. Blood Cancer Journal, 8(7), 67. https://doi.org/10.1038/s41408-018-0102-7
Ailawadhi, S., Parikh, K., Abouzaid, S., Zhou, Z., Tang, W., Clancy, Z.,…Xie, J. (2019). Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: A SEER-Medicare analysis.Blood Advances, 3(20), 2986–2994. https://doi.org/10.1182/bloodadvances.2019000308
Alqazaqi, R., Schinke, C., Thanendrarajan, S., Zangari, M., Shaughnessy, J. J, Zhan, F.,…Al Hadidi, S. (2022). Geographic and racial inequities in access to chimeric antigen receptor-T cells and bispecific antibodies trials for multiple myeloma. Journal of the American Medical Association Network Open, 5(8), e2228877. https://doi.org/10.1001/jamanetworkopen.2022.28877
Amorrortu, R. P., Arevalo, M., Vernon, S. W., Mainous, A. G., 3rd, Diaz, V., McKee, M. D.,…Tilley, B. C. (2018). Recruitment of racial and ethnic minorities to clinical trials conducted within specialty clinics: An intervention mapping approach. Trials, 19(1), 115. https://doi.org/10.1186/s13063-018-2507-9
Barrett, N. J., Boehmer, L., Schrag, J., Benson, A. B., 3rd, Green, S., Hamroun-Yazid,…Guerra, C. E. (2023). An assessment of the feasibility and utility of an ACCC-ASCO implicit bias training program to enhance racial and ethnic diversity in cancer CTs. JCO Oncology Practice, 19(4), OP2200378. https://doi.org/10.1200/OP.22.00378
Benboubker, L., Dimopoulos, M. A., Dispenzieri, A., Catalano, J., Belch, A. R., Cavo, M.,…Facon, T. (2014). Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. New England Journal of Medicine, 371(10), 906–917. https://doi.org/10.1056/nejmoa1402551
Berdeja, J. G., Madduri, D., Usmani, S. Z., Jakubowiak, A., Agha, M., Cohen, A. D.,...Jagannath, S. (2021). Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (andromeda-1): A phase 1b/2 open-label study. The Lancet, 398(10297), 314–324. https://doi.org/10.1016/s0140-6736(21)00933-8
Berner, A. M., Hughes, D. J., Tharmalingam, H., Baker, T., Heyworth, B., Banerjee, S., & Saunders, D. (2020). An evaluation of self-perceived knowledge, attitudes and behaviours of UK oncologists about LGBTQ+ patients with cancer. European Society of Medical Oncologists Open, 5(6), e000906. https://doi.org/10.1136/esmoopen-2020-000906
Bhatnagar, B., Kohlschmidt, J., Mrózek, K., Zhao, Q., Fisher, J. L., Nicolet, D.,…Eisfeld, A. K. (2021). poor survival and differential impact of genetic features of black patients with acute myeloid leukemia. Cancer Discovery, 11(3), 626–637. https://doi.org/10.1158/2159-8290.CD-20-1579
Boggs, J. M., Dickman Portz, J., King, D. K., Wright, L. A., Helander, K., Retrum, J. H., & Gozansky, W. S. (2017). Perspectives of LGBTQ older adults on aging in place: A qualitative investigation. Journal of Homosexuality, 64(11), 1539–1560. https://doi.org/10.1080/00918369.2016.1247539
Boquoi, A., Rings, V., Mohring, A., Savickaite, I., Zukovs, R., Strapatsas, J.,...Fenk, R. (2022). Opportunities for participation in randomized controlled trials for patients with multiple myeloma: Trial access depends on restrictive eligibility criteria and patient expectations. Cancers, 14(9), 2147. https://doi.org/10.3390/cancers14092147
Borno, H. T., Zhang, L., Siegel, A., Chang, E., & Ryan, C. J. (2018). At what cost to clinical trial enrollment? A retrospective study of patient travel burden in cancer clinical trials. The Oncologist, 23(10), 1242–1249. https://doi.org/10.1634/theoncologist.2017-0628
Brigle, K., Verina, D., & Faiman, B. (2022). A focus on newly diagnosed multiple myeloma. Journal of the Advanced Practitioner in Oncology, 13(Suppl 4), 7–14. https://doi.org/10.6004/jadpro.2022.13.5.10
Chaiyasit, J. J., & Lutz, A. R. (2020). LGBTQ perspectives for older adult care. In M. Bolts, E. Capezuti, T. Fulmer, & D. Zwicker (Eds.), Evidence-based geriatric nursing protocols for best practice (6th ed., pp. 194-209). Springer.
Chari, A., Vogl, D. T., Gavriatopoulou, M., Nooka, A. K., Yee, A. J., Huff, C. A.,...Jagannath, S. (2019). Oral selinexor–dexamethasone for triple-class refractory multiple myeloma. New England Journal of Medicine, 381(8), 727–738. https://doi.org/10.1056/nejmoa1903455
Costa, L. J., Brill, I. K., & Brown, E. E. (2016). Impact of marital status, insurance status, income, and race/ethnicity on the survival of younger patients diagnosed with multiple myeloma in the United States. Cancer, 122(20), 3183–3190. https://doi.org/10.1002/cncr.30183
Costa, L. J., Brill, I. K., Omel, J., Godby, K., Kumar, S. K., & Brown, E. E. (2017). Recent trends in multiple myeloma incidence and survival by age, race, and ethnicity in the United States. Blood Advances, 1(4), 282–287. https://doi.org/10.1182/bloodadvances.2016002493
Dimopoulos, M. A., Dytfeld, D., Grosicki, S., Moreau, P., Takezako, N., Hori, M.,...San-Miguel, J. (2018b). Elotuzumab plus pomalidomide and dexamethasone for multiple myeloma. New England Journal of Medicine, 379(19), 1811–1822. https://doi.org/10.1056/nejmoa1805762
Dimopoulos, M. A., Lonial, S., Betts, K. A., Chen, C., Zichlin, M. L., Brun, A.,...Richardson, P. G. (2018a). Elotuzumab plus lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: Extended 4-year follow-up and analysis of relative progression-free survival from the randomized ELOQUENT-2 trial. Cancer, 124(20), 4032–4043. https://doi.org/10.1002/cncr.31680
Dimopoulos, M. A., Moreau, P., Palumbo, A., Joshua, D., Pour, L., Hájek, R.,...Chng, W.-J. (2016a). Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): A randomized, phase 3, open-label, multicentre study. The Lancet Oncology, 17(1), 27–38. https://doi.org/10.1016/s1470-2045(15)00464-7
Dimopoulos, M. A., Oriol, A., Nahi, H., San-Miguel, J., Bahlis, N. J., Usmani, S. Z.,...Moreau, P. (2016b). Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. New England Journal of Medicine, 375(14), 1319–1331. https://doi.org/10.1056/nejmoa1607751
Dimopoulos, M., Quach, H., Mateos, M. V., Landgren, O., Leleu, X., Siegel, D.,…Usmani, S. Z. (2020). Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): Results from a randomised, multicentre, open-label, phase 3 study. Lancet, 396(10245), 186–197. https://doi.org/10.1016/S0140-6736(20)30734-0
Dingli, D., Ailawadhi, S., Bergsagel, P. L., Buadi, F. K., Dispenzieri, A., Fonseca, R.,...Chanan Khan, A. A. (2017). Therapy for relapsed multiple myeloma: Guidelines from the Mayo Stratification for Myeloma and Risk-Adapted Therapy. Mayo Clinic Proceedings, 92(4), 578–598. https://doi.org/10.1016/j.mayocp.2017.01.003
Dong, J., Garacci, Z., Buradagunta, C. S., D’Souza, A., Mohan, M., Cunningham, A.,...Hari, P. (2022). Black patients with multiple myeloma have better survival than white patients when treated equally: A matched cohort study. Blood Cancer Journal, 12(2). https://doi.org/10.1038/s41408-022-00633-5
Duma, N., Azam, T., Riaz, I. B., Gonzalez-Velez, M., Ailawadhi, S., & Go, R. (2018). Representation of minorities and elderly patients in multiple myeloma clinical trials. The Oncologist, 23(9), 1076–1078. https://doi.org/10.1634/theoncologist.2017-0592
Facon, T., Kumar, S., Plesner, T., Orlowski, R. Z., Moreau, P., Bahlis, N.,...Usmani, S. Z. (2019). Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. New England Journal of Medicine, 380(22), 2104–2115. https://doi.org/10.1056/nejmoa1817249
Faiman, B., & Tariman, J. D. (Eds.). (2022). Multiple myeloma: A textbook for nurses (3rd ed.). Oncology Nursing Society Publications Department.
Faiman, B., Gleason, C., Colson, K., & Catamero, D. (2016). Sequencing of treatment and integration of clinical trials. Journal of the Advanced Practitioner in Oncology, 7, 17–29. https://doi.org/10.6004/jadpro.2016.7.2.11
Fiala, M. A., Finney, J. D., Liu, J., Stockerl-Goldstein, K. E., Tomasson, M. H., Vij, R., & Wildes, T. M. (2015). Socioeconomic status is independently associated with overall survival in patients with multiple myeloma. Leukemia & Lymphoma, 56(9), 2643–2649. https://doi.org/10.3109/10428194.2015.1011156
Food and Drug Administration. (2022). FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-teclistamab-cqyv-relapsed-or-refractory-multiple-myeloma
Gibson, A. W., Radix, A. E., Maingi, S., & Patel, S. (2017). Cancer care in lesbian, gay, bisexual, transgender, and queer populations. Future Oncology, 13(15), 1333–1344. https://doi.org/10.2217/fon-2017-0482
Gormley, N., Fashoyin-Aje, L., Locke, T., Unger, J. M., Little, R. F., Nooka, A.,...Anderson, K. C. (2021). Recommendations on eliminating racial inequities in multiple myeloma therapies: A step toward achieving equity in healthcare. Blood Cancer Discovery, 2(2), 119–124. https://doi.org/10.1158/2643-3230.bcd-20-0123
Grant, S. J., Jean-Baptiste, M., Moore, M., Mills, J., Bates, L., Tuchman, S. A., & Mihas, P. (2022). “If you don’t trust your doctor that much...You’d feel less confident doing a research study”: Factors influencing Black patient participation in hematology trials. Blood, 140(Supplement 1), 924–925. https://doi.org/10.1182/blood-2022-167763
Gross, A. S., Harry, A. C., Clifton, C. S., & Della Pasqua, O. (2022). Clinical trial diversity: An opportunity for improved insight into the determinants of variability in drug response. British Journal of Clinical Pharmacology, 88(6), 2700–2717. https://doi.org/10.1111/bcp.15242
Guerra, C., Pressman, A., Hurley, P., Garrett-Mayer, E., Bruinooge, S. S., Howson, A.,...Pierce, L. J. (2023). Increasing racial and ethnic equity, diversity, and inclusion in cancer treatment trials: Evaluation of an ASCO-Association of Community Cancer Centers site self-assessment. Journal of Clinical Oncology: Oncology Practice, 19(4), OP2200560. https://doi.org/10.1200/OP.22.00560
Habr, D., & Corsaro, M. (2022). Reimagining diversity in multiple myeloma clinical trials. Hematological Oncology, 40(4), 689–694. https://doi.org/10.1002/hon.2997
Hamel, L. M., Penner, L. A., Albrecht, T. L., Heath, E., Gwede, C. K., & Eggly, S. (2016). Barriers to clinical trial enrollment in racial and ethnic minority patients with cancer. Cancer Control, 23(4), 327–337. https://doi.org/10.1177/107327481602300404
ICON. (2021). Whitepaper: Paving the way for diversity and inclusion in clinical trials: Establishing a platform for improvement. https://www.iconplc.com/insights/patient-centricity/diversity-and-inclusion-in-clinical-trials/diversity-and-inclusion-in-clinical-trials-whitepaper
Jain, B. S., & Chang, J. H. (2019). Socioeconomic status and survival outcomes in elderly cancer patients: A national health insurance service-elderly sample cohort study. Cancer Medicine, 8(7), 3604–3613. https://doi.org/10.1002/cam4.2231
Jayakrishnan, T., Aulakh, S., Baksh, M., Nguyen, K., Ailawadhi, M., Samreen, A.,...Ailawadhi, S. (2021). Landmark cancer clinical trials and real-world patient populations: Examining race and age reporting. Cancers, 13(22), 5770. https://doi.org/10.3390/cancers13225770
Jowett, A., & Peel, E. (2009). Chronic illness in non-heterosexual contexts: An online survey of experiences. Feminism & Psychology, 19(4), 454–474.
Kamen, C. S., Alpert, A., Margolies, L., Griggs, J. J., Darbes, L., Smith-Stoner, M.,...Norton, S. A. (2019). “Treat us with dignity”: A qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer. Supportive Care in Cancer, 27(7), 2525–2532. https://doi.org/10.1007/s00520-018-4535-0
Kanapuru, B., Fernandes, L. L., Fashoyin-Aje, L. A., Baines, A. C., Bhatnagar, V., Ershler, R.,...Gormley, N. (2022). Analysis of racial and ethnic inequities in multiple myeloma US FDA drug approval trials. Blood Advances, 6(6), 1684–1691. https://doi.org/10.1182/bloodadvances.2021005482
Kano, M., Tamí-Maury, I., Pratt-Chapman, M. L., Chang, S., Kosich, M., Quinn, G. P.,...Sanchez, N. F. (2022). Piloting the Sexual and Gender Minority Cancer Curricular Advances for Research and Education (SGM Cancer CARE) workshop: Research training in the service of SGM Cancer health equity. Journal of Cancer Education. Advance online publication. https://doi.org/10.1007/s13187-022-02233-0
Kaur, G., Mejia Saldarriaga, M., Shah, N., Catamero, D. D., Yue, L., Ashai, N.,...Janakiram, M. (2021). Multiple myeloma in Hispanics: Incidence, characteristics, survival, results of discovery, and validation using real-world and connect MM Registry data. Clinical Lymphoma Myeloma and Leukemia, 21(4). https://doi.org/10.1016/j.clml.2020.11.013
Kazandjian, D. (2016). Multiple myeloma epidemiology and survival: A unique malignancy. Seminars in Oncology, 43(6), 676–681. https://doi.org/10.1053/j.seminoncol.2016.11.004
Kumar, S. K., & Rajkumar, S. V. (2018). The multiple myelomas - current concepts in cytogenetic classification and therapy. Nature Reviews Clinical Oncology, 15(7), 409–421. https://doi.org/10.1038/s41571-018-0018-y
Kumar, S. K., Harrison, S. J., Cavo, M., de la Rubia, J., Popat, R., Gasparetto, C.,...Moreau, P. (2020b). Venetoclax or placebo in combination with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma (BELLINI): A randomised, double-blind, multicentre, phase 3 trial. The Lancet Oncology, 21(12), 1630–1642. https://doi.org/10.1016/s1470-2045(20)30525-8
Kumar, S. K., Jacobus, S. J., Cohen, A. D., Weiss, M., Callander, N., Singh, A. K.,...Rajkumar, S. V. (2020a). Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE): A multicentre, open-label, phase 3, randomised, controlled trial. The Lancet Oncology, 21(10), 1317–1330. https://doi.org/10.1016/s1470-2045(20)30452-6
Lonial, S., Lee, H. C., Badros, A., Trudel, S., Nooka, A. K., Chari, A.,…Cohen, A. D. (2020). Belantamab mafodotin for relapsed or refractory multiple myeloma (DREAMM-2): A two-arm, randomised, open-label, phase 2 study. The Lancet. Oncology, 21(2), 207–221. https://doi.org/10.1016/S1470-2045(19)30788-0
Lonial, S., Weiss, B. M., Usmani, S. Z., Singhal, S., Chari, A., Bahlis, N. J.,...Voorhees, P. M. (2016). Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): An open-label, randomised, phase 2 trial. The Lancet, 387(10027), 1551–1560. https://doi.org/10.1016/s0140-6736(15)01120-4
Loree, J. M., Anand, S., Dasari, A., Unger, J. M., Gothwal, A., Ellis, L. M.,...Raghav, K. (2019). Disparity of race reporting and representation in clinical trials leading to cancer drug approvals from 2008 to 2018. JAMA Oncology, 5(10). https://doi.org/10.1001/jamaoncol.2019.1870
Majhail, N. S., Nayyar, S., Santibañez, M. E., Murphy, E. A., & Denzen, E. M. (2012). Racial inequities in hematopoietic cell transplantation in the United States. Bone Marrow Transplantation, 47(11), 1385–1390. https://doi.org/10.1038/bmt.2011.214
Marinac, C. R., Ghobrial, I. M., Birmann, B. M., Soiffer, J., & Rebbeck, T. R. (2020). Dissecting racial inequities in multiple myeloma. Blood Cancer Journal, 10(2). https://doi.org/10.1038/s41408-020-0284-7
Moloney, C., & Shiely, F. (2022). Underserved groups remain underserved as eligibility criteria routinely exclude them from breast cancer trials. Journal of Clinical Epidemiology, 147, 132–141. https://doi.org/10.1016/j.jclinepi.2022.03.011
Moreau, P., Masszi, T., Grzasko, N., Bahlis, N. J., Hansson, M., Pour, L.,...Richardson, P. G. (2016). Oral Ixazomib, Lenalidomide, and dexamethasone for multiple myeloma. New England Journal of Medicine, 374(17), 1621–1634. https://doi.org/10.1056/nejmoa1516282
Munshi, N. C., Anderson, L. D., Shah, N., Madduri, D., Berdeja, J., Lonial, S.,...San-Miguel, J. (2021). Idecabtagene vicleucel in relapsed and refractory multiple myeloma. New England Journal of Medicine, 384(8), 705–716. https://doi.org/10.1056/nejmoa2024850
National Black Caucus of State Legislators. (2022). NBCSL. https://NBCSL.org
Nipp, R. D., Hong, K., & Paskett, E. D. (2019). Overcoming barriers to clinical trial enrollment. American Society of Clinical Oncology Educational Book, 39, 105–114. https://doi.org/10.1200/edbk_243729
Palumbo, A., Chanan-Khan, A., Weisel, K., Nooka, A. K., Masszi, T., Beksac, M.,...Sonneveld, P. (2016). Daratumumab, bortezomib, and dexamethasone for multiple myeloma. New England Journal of Medicine, 375(8), 754–766. https://doi.org/10.1056/nejmoa1606038
Pierre, A., & Williams, T. H. (2020). African American patients with multiple myeloma: Optimizing care to decrease racial inequities. Clinical Journal of Oncology Nursing, 24(4), 439–443. https://doi.org/10.1188/20.CJON.439-443
Rajkumar, S. V. (2020). Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. American Journal of Hematology, 95(5), 548–567. https://doi.org/10.1002/ajh.25791
Richardson, P. G., Jacobus, S. J., Weller, E. A., Hassoun, H., Lonial, S., Raje, N. S.,...Munshi, N. C. (2022). Triplet therapy, transplantation, and maintenance until progression in myeloma. New England Journal of Medicine, 387(2), 132–147. https://doi.org/10.1056/nejmoa2204925
Richardson, P. G., Oriol, A., Beksac, M., Liberati, A. M., Galli, M., Schjesvold, F.,...Yee, A. (2019). Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with Lenalidomide (OPTIMISMM): A randomised, open-label, phase 3 trial. The Lancet Oncology, 20(6), 781–794. https://doi.org/10.1016/s1470-2045(19)30152-4
San-Miguel, J. F., Hungria, V. T., Yoon, S.-S., Beksac, M., Dimopoulos, M. A., Elghandour, A.,...Richardson, P. G. (2016). Overall survival of patients with relapsed multiple myeloma treated with panobinostat or placebo plus bortezomib and dexamethasone (the panorama 1 trial): A randomised, placebo-controlled, phase 3 trial. The Lancet Haematology, 3(11). https://doi.org/10.1016/s2352-3026(16)30147-8
Schabath, M. B., Blackburn, C. A., Sutter, M. E., Kanetsky, P. A., Vadaparampil, S. T., Simmons, V. N.,...Quinn, G. P. (2019). National survey of oncologists at National Cancer Institute-designated comprehensive cancer centers: Attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer. Journal of Clinical Oncology, 37(7), 547–558. https://doi.org/10.1200/JCO.18.00551
Shah, J. J., Abonour, R., Gasparetto, C., Hardin, J. W., Toomey, K., Narang, M.,...Rifkin, R. M. (2017). Analysis of common eligibility criteria of randomized controlled trials in newly diagnosed multiple myeloma patients and extrapolating outcomes. Clinical Lymphoma, Myeloma & Leukemia, 17(9), 575–583.e2. https://doi.org/10.1016/j.clml.2017.06.013
Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer Statistics, 2024. CA: A Cancer Journal for Clinicians, 74(1), 12–49. https://doi.org/10.3322/caac.21820
Smith-Graziani, D., & Flowers, C. R. (2021). Understanding and addressing inequities in patients with hematologic malignancies: Approaches for clinicians. American Society of Clinical Oncology Educational Book, (41), 351–357. https://doi.org/10.1200/edbk_320079
Stewart, A. K., Rajkumar, S. V., Dimopoulos, M. A., Masszi, T., Špička, I., Oriol, A.,...Palumbo, A. (2015). Carfilzomib, Lenalidomide, and dexamethasone for relapsed multiple myeloma. New England Journal of Medicine, 372(2), 142–152. https://doi.org/10.1056/nejmoa1411321
Sutter, M. E., Simmons, V. N., Sutton, S. K., Vadaparampil, S. T., Sanchez, J. A., Bowman-Curci, M.,...Quinn, G. P. (2021). Oncologists’ experiences caring for LGBTQ patients with cancer: Qualitative analysis of items on a national survey. Patient Education & Counseling, 104(4), 871–876.
U.S. Department of Health and Human Services. (2021). Healthy People 2030. https://health.gov/our-work/national-health-initiatives/healthy-people/healthy-people-2030/questions-answers
Unger, J. M., Cook, E., Tai, E., & Bleyer, A. (2016). The role of clinical trial participation in cancer research: Barriers, evidence, and strategies. American Society of Clinical Oncology Educational Book, 36, 185–198. https://doi.org/10.1200/edbk_156686
Ussher, J. M., Perz, J., Allison, K., Power, R., Hawkey, A., Dowsett, G. W.,...Anazodo, A. (2022). Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study. Patient Education and Counseling, 105(7), 2512–2523. https://doi.org/10.1016/j.pec.2021.12.008
Voorhees, P. M., Kaufman, J. L., Laubach, J., Sborov, D. W., Reeves, B., Rodriguez, C.,...Richardson, P. G. (2020). Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: The GRIFFIN trial. Blood, 136(8), 936–945. https://doi.org/10.1182/blood.2020005288
Vuong, I., Wright, J., Nolan, M. B., Eggen, A., Bailey, E., Strickland, R.,...Downs, T. (2020). Overcoming barriers: Evidence-based strategies to increase enrollment of underrepresented populations in cancer therapeutic clinical trials-a narrative review. Journal of Cancer Education, 35(5), 841–849. https://doi.org/10.1007/s13187-019-01650-y
Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychology, 35(4), 407–411. https://doi.org/10.1037/hea0000242
