Collaborative Strategies to Enhance Treatment and Integration of Cellular Therapies in Multiple Myeloma: Results from Nationwide Multiple Myeloma Patient and Provider Surveys

Background

The multiple myeloma (MM) treatment landscape has advanced significantly, with a plethora of different therapy options, combinations and mechanisms, necessitating effective decision-making and communication among specialists. A prior quality improvement (QI) initiative assessing collaboration between community oncology clinics and regional CAR T-cell centers revealed critical gaps in disease documentation, patient management, and communication between providers. To uncover root causes underlying these gaps to improve MM care, we conducted nationwide surveys of MM providers and patients.

Methods

Surveys were electronically distributed to 152 hematology healthcare providers (HCPs) and 99 patients with MM to assess challenges in integrating cellular therapies into MM treatment. The HCPs, averaging 14 years of MM care experience, included 55% hematologists, 2% medical oncologists, 7% nurse practitioners or physician assistants, 22% nurses, and 13% pharmacists, managing about 4,259 MM patients. Among the patients, 89% had received 1^st line (1L) therapy, 28% 2L, and 11% 3L or more. The surveys, featuring shared questions, aimed to identify alignments and discordances in beliefs and perceptions regarding MM care.

Results

Top provider-reported challenges in managing MM included keeping up with new clinical evidence (53%), optimal sequencing of therapies (45%), and knowing when to switch therapies (43%). Despite a majority expressing high/very high confidence in aligning practice with guidelines (66%), sequencing/differentiating novel MM therapies (66%), and staying updated with new treatments (69%), a significant minority lacked confidence in these areas. To improve confidence and enhance MM care, providers recognized the need for education on managing adverse events of MM therapies (57%), strategies for selecting and sequencing therapies (55%), and improving insurance approval processes (44%).

Results from patient surveys revealed a significant discord in perceptions of MM care between patients and providers. Providers identified the main barriers to eligible MM patients receiving CAR T-cell therapy as difficulty gaining insurance approval (50%), referral challenges or lack of available spots (47%), and patient resistance (43%). In contrast, patients cited the primary reasons as a lack of discussion about CAR T-cell therapy by their doctors (64%) and ineligibility (41%). Further discrepancies emerged in perceptions of treatment discussions. While 58% of providers believed they thoroughly discussed the pros and cons of different treatments, only 42% of patients agreed. Similarly, 53% of providers felt they addressed long-term side effects, compared to just 22% of patients. Emotional needs discussions were noted by 49% of providers, but only 15% of patients felt the same. Half of the patients expressed a desire for more detailed discussions about different treatments. Additionally, although 70% of patients felt consistently involved in treatment decisions, they wanted better discussions on realistic treatment expectations and prognosis (28%), as well as more education on MM treatment options (23%).

The quality of collaboration between CAR T-cell centers and oncology clinics received high ratings from providers, with 63% rating very good or excellent. However, those who rated it lower pointed out challenges such as insufficient sharing of patient information (45%) and lack of time for communication (29%).

Conclusions

HCPs face significant barriers in integrating cellular therapies for MM, including inefficient communication between centers, access to CAR T-cell therapy, keeping up with new clinical evidence, and effectively discussing treatment options with patients. Discrepancies in perceptions regarding communication levels between providers and patients were also observed. To optimize MM care, addressing educational gaps and improving communication and collaboration among care teams are crucial. Enhancing provider education on new therapies, streamlining insurance approval processes, and fostering comprehensive patient discussions about treatment options can greatly enhance MM management and outcomes.

Study Sponsor Statement

The study reported in this abstract was supported by an educational grant from Sanofi, who had no role in the study design, execution, analysis, or reporting.