The document discusses access to healthcare, specifically for elderly patients with multiple myeloma (MM). It notes that the incidence of myeloma peaks in patients aged 65-74 years old, but that elderly patients have faced limited access to hematopoietic cell transplantation (HCT). Several possible reasons for this discrepancy are proposed, including patients over 65 historically not being candidates for HCT, exclusion from clinical trials, comorbidities, and patient preference.

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Access to Health Care Is Defined as Receiving
Timely Cost-Effective Health Care
Definition
• Cost-effective, appropriate
health care to achieve best
possible outcome
• Timely performance of
health care services
• Influenced by health care
providers (HCPs), patients,
and health care systems
Goal
• Optimal health outcomes © iStockphoto.com / sjlocke.
Joshua TV, et al. Cancer. 2010;116(14):3469-3476.

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The Incidence of Myeloma Peaks in Patients
65 to 74 Years of Age
Age at Myeloma Diagnosis
30
25
Diagnoses, %
20
15
10
5
0
<20 20-34 35-44 45-54 55-64 65-74 75-84 ≥85
Age, years
Surveillance epidemiology and end results. SEER Stat Fact Sheets: Myeloma. National Cancer Institute Web site. http://seer.cancer.gov/statfacts/html/mulmy.html.
Accessed October 21, 2012.

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Several Reasons for Limited Access to HCT Among
Elderly Patients With MM Have Been Proposed
• Possible reasons for discrepancy
– Patients ≥65 years historically not candidates for HCT1
– Elderly patients excluded from clinical trials2
– Comorbidity3
– Patient preference3
“Advanced age alone should not preclude the use of
effective cancer treatment that could improve quality of
life or extend meaningful survival.”4
‒NCCN Guidelines for Senior Adult Oncology
1. Palumbo A, Gay F. Hematology Am Soc Hematol Educ Program. 2009:566-577.
2. Kumar SK, et al. Am J Hematol. 2008;83(8):614-617.
3. Majhail NS, et al. Biol Blood Marrow Transplant. 2010;16(8):1070-1075.
4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Senior Adult Oncology. v2.2012.

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