"I Missed My Other Oncologist": Established Relationships as Barriers and Facilitators to Accessing CAR-T and Autologous Transplantation

BACKGROUND: Autologous stem cell transplantation (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) can provide significant clinical benefit, but are not equally available to all patients. Oncologist continuity and trust are important to patients, and may act as barriers to receipt of therapy. However, detailed data are lacking on the mechanism by which these might affect receipt of therapy, or how this barrier may be overcome.

METHODS: We conducted a qualitative interview study with patients with non-Hodgkin lymphoma (NHL), classic Hodgkin lymphoma (cHL) or multiple myeloma (MM) eligible for or treated with ASCT/CAR-T. Participants were recruited from a multi-site academic health system that includes a safety net hospital considered to be one of the most racially inclusive in the country. Interviews were independently coded by two trained coders.

RESULTS: Forty patients participated. Half were female, 65% had multiple myeloma, 45% identified as Black or African American, 22.5% had an income less than $30,000 and 33% were insured with Medicaid. In addition to treatment-specific factors and logistical factors such as housing and transportation, patients identified the need to establish care and trust with a new provider as potential barriers to receipt of therapy. This process could be facilitated by the perception of strong communication and existing relationships between patients' established and new providers.

CONCLUSIONS: In addition to logistical and clinical factors, several factors centering around existing and newly required patient-provider relationships may influence patients' acceptance of ASCT/CAR-T. Acceptance may be enhanced by addressing relationship-based barriers in a manner that emphasizes continuity and helps build trust with a new provider, such as by explicitly demonstrating seamless communication among care teams.