Barriers to CAR T-Cell Referral and Center Access in Multiple Myeloma

This segment examines why many patients with relapsed or refractory multiple myeloma fail to reach authorized CAR T-cell treatment centers despite being eligible. Dr. Kaur explains that the most common barriers occur early in the referral pathway and include lack of awareness among community clinicians about modern CAR T indications, misconceptions that CAR T should be reserved only for late lines, and concerns about toxicity that no longer reflect current practice. Geographic distance and travel burden are significant obstacles, as many patients would need to commute more than one to two hours to reach a certified center. Patients may also hesitate to shift care away from local oncologists they trust. Additional challenges include caregiver requirements, insurance delays, housing costs, and the perceived complexity of the CAR T process. The most addressable issues involve education for clinicians and patients, early referral, streamlined communication between community and academic centers, and support systems that assist with logistics and coordination.