title: Low uptake of upfront autologous transplantation for myeloma in a jurisdiction with universal health care coverage: a population-based patterns of care study in Australia.
abstract: BACKGROUND
  Guidelines for the management of symptomatic multiple myeloma (MM) recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible patients.
  
  
  METHODS
  Using population-based data, we examined the characteristics of transplant-eligible patients who do not undergo upfront ASCT. Altogether, 686 newly diagnosed MM cases were identified through the population-based central cancer registry in Victoria, Australia from 2008 to 2009. We performed a detailed review of clinical notes and follow-up for at least 12 months after diagnosis for a subset of 225 patients who were aged < 70 years at diagnosis and had symptomatic MM.
  
  
  RESULTS
  Of these 225 patients, 123 (55%) proceeded to receive upfront ASCT. Patient and disease factors associated with not receiving upfront ASCT were the presence of severe medical comorbidities, MM-associated renal impairment, and initial referral to a medical oncologist rather than a hematologist. Place of residence (rural vs. metropolitan) was not significant. Of 121 patients aged < 65 years at diagnosis who had minor or no comorbidities, only 75 (62%) proceeded to upfront ASCT.
  
  
  CONCLUSIONS
  A substantial percentage of apparently transplant-eligible patients with newly diagnosed MM do not proceed to upfront ASCT. Community practice appears to diverge from clinical guidelines. The reasons for this divergence require further study but reasons may include perceptions of toxicity vs. benefits of upfront ASCT.
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wong Doo
authors.affiliation: Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Cancer Strategy and Development, Department of Health, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.affiliation: The Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Melbourne, Victoria, Australia. Electronic address: vicki.white@cancervic.org.au.
authors.forename: Victoria
authors.initials: V
authors.lastname: White
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Harrison
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
authors.affiliation: Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Millar
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Dimech
authors.affiliation: Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia; Cancer Strategy and Development, Department of Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
mesh_terms: D000368:Aged; D001315:Australia; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods
keywords: Epidemiology; Multiple myeloma; Stem cell transplantation