This article was auto-translated from Italian. The original version, by Stefano della Casa, is available on the GIMEMA website at the following link: https://www.gimema.it/eha2025-disuguaglianze-socio-economiche-peggiorano-qualita-vita-pazienti-mieloma-multiplo-recidivante/
Socio-economic status is associated with worse quality of life outcomes, even within a public healthcare system. The results of the GIMEMA-CLARITY study were presented at the European Hematology Association (EHA) congress 2025.
Unfortunately, even a universal healthcare system does not automatically ensure equal health conditions for all citizens. This is confirmed by an analysis of data collected in the observational GIMEMA-CLARITY study, presented at EHA 2025: among patients with relapsed or refractory multiple myeloma (RRMM), those with lower socio-economic status show a significantly worse quality of life.
The issue of inequalities in hematology is not new for GIMEMA researchers. For example, in a previous study published in 2024, the Foundation’s researchers analyzed the impact of financial toxicity in a large cohort of patients with various blood disorders—including chronic myeloid leukemia, myelodysplastic syndromes, and multiple myeloma—showing that economic difficulties related to the disease were associated with reduced quality of life.
Financial toxicity refers to the economic burden—both direct and indirect—that patients face due to their disease: transportation costs, loss of income, uncovered medications, and private care. This impact has been documented even in countries like Italy, where a public healthcare system is in place.
The results presented at the congress focused specifically on RRMM and explored the relationship between patients’ socio-economic status and their quality of life. Francesco Sparano, researcher and data manager of the Quality of Life Unit at the GIMEMA Foundation and first author of the study, explained:
“In this work, we focused on socio-economic status as an independent determinant. Literature has already established that lower socio-economic status is associated with worse survival and poorer quality of life. This study confirms it, even within a universal healthcare system.”
A focused analysis
For this study, researchers analyzed data from CLARITY (Clinical and Patient-Reported Outcomes in Relapsed/Refractory Myeloma Therapy), a multicenter observational study promoted by the GIMEMA Foundation, aimed at collecting clinical and quality of life data in patients with relapsed or refractory multiple myeloma.
The study systematically includes patient-reported outcomes (PROs) through validated questionnaires, with the goal of better understanding patients’ subjective experience during the disease and its treatment.
Researchers chose to focus on patients with RRMM because they represent a population particularly exposed to inequalities.
“Patients with RRMM typically receive multiple lines of treatment over the course of their disease, often for long periods. This results in a greater therapeutic and logistical burden, which can amplify barriers to accessing care for those with fewer resources.”
Previous literature had already suggested that socio-economic inequalities may have a stronger impact in patients with hematologic malignancies compared to those with solid tumors, precisely because of the longer and more complex treatment pathways. The CLARITY data allowed this hypothesis to be explored more specifically.
The analysis included 505 patients with RRMM enrolled in Italy and, to a lesser extent, in the United Kingdom. Socio-economic status (SES) was calculated using three indicators: level of education, living conditions (living alone or with others), and the presence or absence of income from employment or pension. These were combined into a composite index, allowing patients to be classified into three groups: low, intermediate, and high SES.
“We preferred to use a composite index to capture the interaction between multiple factors. It is not a single element that determines socio-economic status, but the accumulation of different aspects. This approach is also supported by previous studies.”
Quality of life was assessed using two standardized tools: the EORTC QLQ-C30 questionnaire, widely used in oncology, and the QLQ-MY20, which is specific for multiple myeloma.
The differences in scores were significant. Patients with relapsed multiple myeloma and low SES reported worse quality of life across almost all analyzed scales, with higher levels of symptoms such as insomnia, pain, fatigue, and greater impairment in emotional well-being.
“From a symptomatic perspective, pain and fatigue are already common in multiple myeloma patients, but among those with low socio-economic status we observed an even higher prevalence of clinically relevant symptoms. This raises interesting questions: we know some possible explanations from the literature, but it will be important to further investigate the mechanisms that make these patients more vulnerable, also from a physical standpoint.”
“It is interesting to note that most patients with lower socio-economic status were women. This reflects a well-known reality, especially in Italy: higher unemployment rates among women and greater social isolation in older age groups, partly due to longer life expectancy. The relationship between SES and quality of life remains valid for both sexes, but the higher proportion of women in the disadvantaged group is an important warning signal.”
Limitations and future perspectives
Despite the inclusion of patients from the United Kingdom, they represented only a small minority (just one of the 31 enrolling centers).
“For this reason, it was not possible to perform meaningful comparisons between Italy and the UK. Similarly, regional analyses within Italy would not be informative, since we do not know the actual place of residence of patients, but only the center where they were treated.”
However, the author points out that similar results have been observed in European studies on solid tumors in countries such as Denmark and the Netherlands, suggesting a common trend across public healthcare systems.
According to Sparano, these findings are based on the hypothesis that socio-economic status, financial toxicity, and quality of life are closely interconnected. More disadvantaged patients not only start from a more fragile condition, but are also more likely to experience financial toxicity due to treatment-related costs, which in turn further worsens their clinical experience and overall well-being.
“In this abstract, we focused on the first level of analysis—the relationship between socio-economic status and quality of life—but our goal is to explore in a broader and more structured way the interaction between these three factors.”
How can these findings be translated into concrete interventions?
“One possible approach is to identify patients at higher risk of poor quality of life early on, including through socio-economic indicators, and to integrate this information into clinical decision-making. This could help guide supportive interventions, such as psychological support, social services, or logistical assistance.”
“The goal is not only to treat the disease, but also to reduce inequalities that may negatively impact patients’ overall well-being. Integrating patient-reported outcomes with socio-economic data could represent an important step toward more equitable and patient-centered care.”