Review Article

Diversity, Equity, and Inclusion in Multiple Myeloma: A Call to Action

Rebecca Lu,(1) MSN, FNP-C, Joseph D. Tariman,(2) PhD, MBA, ANP-BC, FAAN, Donna Catamero,(3) ANP-BC, OCN, CCRC, Michaela Hillengass,(4) RN, CPT, ACSM, and Kimberly Noonan,(5) DNP, ANP-BC, AOCN®

From (1)The University of Texas MD Anderson Cancer Center, Houston, Texas; (2)Rutgers University, Camden, New Jersey; (3)Mount Sinai, New York, New York; (4)Roswell Park Comprehensive Cancer Center, Buffalo, New York; (5)Dana-Farber Cancer Institute, Boston, Massachusetts

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Rebecca Lu, MSN, FNP-C, 1515 Holcombe Boulevard, Houston, Texas 77030 E-mail: rlu@mdanderson.org

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.

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