Referral Barriers to Chimeric Antigen Receptor T-Cell Therapy in Multiple Myeloma

Referral barriers can limit access to chimeric antigen receptor (CAR) T-cell therapy for patients with multiple myeloma. Doris Hansen, MD, and Prerna Mewawalla, MD, discuss challenges including travel distance, caregiver requirements, social determinants of health, and referrals that occur late in the treatment course. Dr. Mehwawala describes patients who may be reluctant to travel or stay near an academic treatment center and emphasizes that age alone should not preclude CAR T-cell therapy. Dr. Hansen notes that approximately 20% to 30% of eligible patients in her practice are referred for CAR T-cell consultation and identifies travel distance and neighborhood disadvantage as potential barriers. Both physicians discuss strategies to improve referral and access, including direct communication between community and academic treatment centers and greater awareness of CAR T-cell therapy earlier in treatment. They also address long-term outcomes and health-related quality of life, including how to discuss prolonged progression-free survival while recognizing that individual outcomes cannot be predicted from clinical trial results.