How Academic/Community Oncologists Improve Access to New Myeloma Therapies

Access to newer multiple myeloma therapies varies considerably depending on where a patient is treated, both globally and within the US. C. Ola Landgren, MD, PhD, estimated that patients treated in the US generally have access to therapies that are roughly a decade ahead of what is available in Europe, South America, Asia, or Australia. But even within the US, meaningful disparities exist between academic centers and private practice, which are driven largely by differences in patient volume and the resulting familiarity with a rapidly evolving treatment landscape.

In an interview with CancerNetwork^® at the 23rd Annual International Myeloma Society (IMS) Meeting & Exposition, Landgren discussed these disparities and how his institution works to address them. He explained that clinicians in these settings are frequently focused on more common cancers, such as breast, prostate, colorectal, and lung cancer, leaving less time to stay up to date on the details of a less frequently encountered disease like multiple myeloma. Landgren noted that this dynamic, observed across multiple studies, contributes to a slower uptake of newer therapies in community settings, along with potential delays in referrals to specialized centers as patients and physicians wait to transition toward newer treatment options.

To address this, Landgren described his center’s approach to close collaboration with community physicians rather than positioning academic centers as competitors for patients. That includes participating in local educational programs, sharing direct cell phone access with private practice doctors, and maintaining clear communication that emphasizes shared patient care rather than patient retention.

Landgren is a professor, chief of the Division of Myeloma in the Department of Medicine, director of the Sylvester Myeloma Institute, co-leader of the Translational and Clinical Oncology Program, and Paul J. DiMare Endowed Chair in Immunotherapy at the University of Miami Miller School of Medicine. He is also an editorial advisory board member of the journal ONCOLOGY®.

Transcript:

CancerNetwork: There’s a huge diversity in how patients with multiple myeloma are managed worldwide and within the US. What drives that disparity, and how does your center work to address it?

I know there is a huge diversity in how patients are [treated] worldwide. To a high degree, this is because access to these newer drugs that are being presented here at the IMS meeting, other meetings, and in publications, and so forth, varies greatly. In the US, we have access to therapies that are probably maybe a decade ahead of what you can see, say, in Europe, South America, Asia, Australia, and so forth. At the same time, within the US, there are huge differences, say, [with] the academic centers vs the private practice doctors. The academic centers may have programs that see many patients. At our center, we see over 10,000 visits for multiple myeloma in 1 year, which is a very high number. At many of the private practice clinics, there are clinics that see maybe 1 [to 5 patients with multiple myeloma] per year, and those patients may come once a month or every 3 months. The number of visits per year is significantly lower than, say, our program and many other bigger programs.

Of course, the experience with the different drugs varies because if you work in private practice and you see the more common cancers [like] breast cancer, prostate cancer, colorectal cancer, and lung cancer, that means you spend most of your time working on those cancers. But if you have one [patient with] multiple myeloma, not so frequently coming in, you may not be aware of all the details, and I think that’s very understandable, and it’s very reasonable. I think what we see, and what’s been found in different studies, is that there is a slower uptake of the new therapies, and you can also see that patients are waiting to shift toward the newer therapies; the referrals could be delayed, and so forth.

I think a good way to overcome that is to be a good advocate; we have tried that, and we keep on doing this over and over again. We participate in local educational programs. We always share our cell phone numbers with all the local private practice doctors, and we also make it very clear that we are not stealing patients from anyone. We are helping. We are working as one team. Patients have come to us, we will help, we will document what we do, and we will also call them and say, “I saw your patient, this is what we recommended.” We recommend the patient go back to the local doctor, which may be easier for the patient because the doctor’s office may be closer to where the patient lives. We are helping. If they ever need anything, they’re always welcome back. It’s about teamwork, education, and helping each other.