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Papers by maira avila

Purpose Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple my... more Purpose Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple myeloma. This qualitative study described patient (n = 14) experiences and healthcare providers’ (n = 8) opinions and practices concerning care for patients with MGUS in the US. Methods Semi-structured, in-depth interviews were analyzed using thematic analysis. Results We identified six overarching themes related to the care pathway for patients with MGUS. (1) Process of MGUS diagnosis, (2) Providers’ explanations, (3) Patients’ understanding, (4) Impact of the diagnosis, (6) follow-up/management, and (6) factors influencing healthcare utilization. Patients demonstrated a basic understanding of MGUS. However, some patients felt anxiety around the diagnosis, which may affect other aspects of their lives. Non-hematologist providers report having less MGUS-specific knowledge. Older age, high-risk MGUS, and insurance/cost influenced healthcare utilization. Conclusion Patients with MGUS may hav...

Clinical Lymphoma Myeloma and Leukemia

Hematological Oncology, 2022

Understanding the progression of monoclonal gammopathy of undetermined significance (MGUS) to mul... more Understanding the progression of monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM) is needed to identify patients who would benefit from closer clinical surveillance. Given that two of the defining criteria of multiple myeloma are renal failure and anemia, we described the trajectories of creatinine (Cr) and hemoglobin (Hgb) over time in patients with a diagnosis of MGUS. Patients diagnosed with MGUS (n=424) were identified by a previously validated case-finding algorithm using health claims and electronic health record data (2007-2015) and followed through 2018. Group-based trajectory modeling identified patients with distinct laboratory value trajectories of Cr (mg/dL) and Hgb (g/dL). Most patients were non-Hispanic White (97.6%) with a mean age of 75 years at MGUS diagnosis. Three multi-trajectory groups were identified: 1) Normal Cr/Hgb (n=225; 53.1%) - stable serum Cr levels and decreasing, normal Hgb levels; 2) Normal Cr/lower-normal Hgb group (n=188; 44.3%) - stable, slightly elevated levels of Cr and decreasing levels of Hgb; and 3) High Cr/borderline Hgb group (n=11; 2.6%) - increased Cr levels and stable low levels of Hgb. Patients with MGUS in Group 2 were older than patients in other groups, and patients in group 3 had more comorbidities than participants in all other groups. Few patients developed multiple myeloma during the study period. We were able to identify distinct biomarker trajectories in patients with MGUS over time. Future research should investigate how these trajectories may be related to the risk of progression to multiple myeloma, including M-protein levels. This article is protected by copyright. All rights reserved.

Background/Objective: Multiple myeloma (MM) is an incurable, yet treatable, cancer of plasma cell... more Background/Objective: Multiple myeloma (MM) is an incurable, yet treatable, cancer of plasma cells. Due to recent improvements in treatment, people diagnosed with MM have been living longer, and other co-morbid conditions may be of increasing importance. This study examines temporal trends in specific causes of death among MM patients in Puerto Rico (PR) and United States (US). Methods: We analyzed primary cause of death among all incident MM cancer cases recorded in the Puerto Rico Central Cancer Registry (PRCCR) (n=3,018) and the US Surveillance, Epidemiology, and End Results Program (SEER) (n=67,733) between 1987-2013, overall and by follow-up time, age, and sex. We calculated the cumulative incidence of death due to seven selected causes and analyzed age-adjusted mortality trends by MM and other causes using joinpoint regression. Results: MM accounted for 71.7% and 71.3% of all reported deaths in PR and US, respectively, among people diagnosed with MM. In PR, the proportion of p...

Cancer Epidemiology, Biomarkers & Prevention, 2022

Background: Monoclonal gammopathy of undetermined significance (MGUS) is a prevalent, yet inciden... more Background: Monoclonal gammopathy of undetermined significance (MGUS) is a prevalent, yet incidentally diagnosed precursor to multiple myeloma. We sought to gather foundational knowledge about the experiences of patients and healthcare providers during the process of diagnosing MGUS. Methods: We conducted semi-structured qualitative interviews. We recruited 14 patients using ResearchMatch and Facebook, and eight local healthcare providers. Interviews were analyzed using thematic analysis. Results: We identified three themes focused on the process of receiving or giving an MGUS diagnosis, relating to: (1) providers' explanations, (2) patients' understanding, and (3) the response to diagnosis. Providers reported that they explained MGUS using similar language for all patients, regardless of literacy level or other factors. Providers also indicated the challenges of explaining MGUS to non-English speaking patients using an interpreter. Although all patients were able to offer s...

Cancer Causes & Control, 2021

Purpose-We examined the combined influences of race/ethnicity and neighborhood socioeconomic stat... more Purpose-We examined the combined influences of race/ethnicity and neighborhood socioeconomic status (SES) on long-term survival among patients with multiple myeloma (MM). Methods-Data from the 2000-2015 NCI Surveillance, Epidemiology, and End Results Program (SEER-18) were used. Census tract-level SES index was assessed in tertiles (low, medium, high SES). Competing-risk modeling was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CIs) for SES tertile adjusted for sex and age at diagnosis and stratified by race/ethnicity. Results-Overall, living in a low SES neighborhood was associated with worse MM survival. However, we observed some variation in the association by racial/ethnic group. Living in a low versus a high SES neighborhood was associated with a 35% (95% CI = 1.16-1.57) increase in MM-specific mortality risk among Asian/Pacific Islander cases, a 17% (95% CI = 1.12-1.22) increase among White cases, a 14% (95% CI = 1.04-1.23) increase among Black cases, and a 7% (95% CI = 0.96-1.19) increase among Hispanic cases. Conclusion-These results suggest that the influence of both SES and race/ethnicity should be considered when considering interventions to remedy disparities in MM survival.

Health Equity, 2020

Purpose: Limited English proficiency adversely impacts people's ability to access health services... more Purpose: Limited English proficiency adversely impacts people's ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA). Methods: Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted n = 240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: ''How well do you speak English? Would you say. Very well; well; Not well; Not at all?'' (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and ''What language do you speak at home? Would you say. English, Spanish, Other.'' Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report. Results: Among those < 65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those ‡ 65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates. Conclusion: Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English.

Annals of Hematology, 2021

Monoclonal gammopathy of undetermined significance (MGUS), precursor of multiple myeloma, is an a... more Monoclonal gammopathy of undetermined significance (MGUS), precursor of multiple myeloma, is an asymptomatic plasma cell disorder that overproduces serum monoclonal protein. Older age, male sex, black race, and family history of MGUS increase the risk of MGUS, yet other risk factors are known. We systematically reviewed observational epidemiological studies that examined sociodemographic, clinical, and behavioral risk factors for the development of MGUS. The protocol for this study was registered on the PROSPERO registry for systematic reviews. We identified epidemiological studies from PubMed and Scopus. Articles were limited to those written in English and published before February 2019. Five case-control and three cohort studies were eligible for data extraction. Studies evaluating factors associated with MGUS risk are limited, with conflicting conclusions regarding risk associated with obesity. Despite the limited research, a significant elevated risk for being diagnosed with MGUS was associated with several specific prior infections, inflammatory disorders, and smoking. The sparse existing literature suggests an increased risk of MGUS associated with several risk factors related to immune function. Further research is needed to explore the potential mechanisms underlying the development of MGUS and to confirm risk factors, both modifiable and non-modifiable.

Cancer Epidemiology, Biomarkers & Prevention, 2020

Background: Over 114,000 new cases of lymphoid malignancies (LM), including Hodgkin lymphoma (HL)... more Background: Over 114,000 new cases of lymphoid malignancies (LM), including Hodgkin lymphoma (HL), Non-Hodgkin lymphoma (NHL) and multiple myeloma (MM), are diagnosed annually. However, little is known about the influence of socioeconomic status (SES) on LM survival among Hispanics, who comprise 18% of the US population. This study evaluates the association between area-based SES and survival of Hispanic LM patients compared with non-Hispanic whites and non-Hispanics blacks. Methods: All LM reported to the NCI Surveillance, Epidemiology, and End Results Program (SEER-18) diagnosed between 2000-2015 were included. Census tract-level socioeconomic status (SES) was assessed in tertiles. Cox proportional hazards models estimated hazard ratios (aHR) to evaluate SES with cause-specific survival, adjusted for sex, stage at diagnosis, radiation, surgery and chemotherapy. All analyses were stratified by race/ethnicity. Results: Hispanics with low SES diagnosed with MM were 30% (aHR:1.3, 95% ...

Clinical and Experimental Dental Research, 2020

The relationship of aging, complete tooth loss, and having a The relationship of aging, complete ... more The relationship of aging, complete tooth loss, and having a The relationship of aging, complete tooth loss, and having a dental visit in the last 12 months dental visit in the last 12 months

SAGE Open Medicine, 2020

Objectives: This study sought to provide population-based estimates of complete tooth loss and re... more Objectives: This study sought to provide population-based estimates of complete tooth loss and recent dental visits among older adults in the United States by English language proficiency. Methods: We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants ⩾50 years of age (n = 10,452, weighted to represent 111,895,290 persons). Five categories of language proficiency were created based on self-reported English language ability and language spoken at home (Spanish, Other). Results: The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%, English only: 12.0%). Complete tooth loss was less common among participants for whom Spanish was their primary language, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42–0....

International Journal of Cancer, 2019

Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a resu... more Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co-morbid conditions may be of increasing importance to MM patients' long-term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age-standardized temporal trends showed a decreased MM-specific mortality rate among US SEER (annual percent change [APC] = −5.0) and Puerto Rican (APC = −1.8) patients during the study period, and particularly after 2003 in non-Hispanic SEER patients. Temporal decline in non-MM causes of death was also observed among US SEER (APC = −2.1) and Puerto Rican (APC = −0.1) populations. MM-specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26-year period. The most pronounced decreases in MMspecific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.