Critical factors influencing clinical trial enrollment and autologous stem cell transplantation in African-American patients with multiple myeloma: A retrospective, interview-based analysis

Abstract Purpose: The backbone of multiple myeloma (MM) therapy include chemotherapy, targeted therapies, autologous stem cell transplantation (ASCT), amongst others. Patient enrollment in clinical trials and uptake of complex interventions such as ASCT is crucial for these advancements and to improve patient outcomes. Furthermore, MM is more than twice as common in Black/African-American (B/AA) persons, yet many B/AA people decline to enroll in clinical trials or undergo transplant. However, at the Cleveland Clinic, many B/AA patients do elect to undergo ASCT and enroll in clinical trials. We interview these patients to understand the conditions under which B/AA patients elect trial/transplant. Experimental Procedures: To study differences in access to care, which have the potential to lead to differences in survival and disease progression, we conduct semi-structured interviews with patients to better understand the breadth of their complex decision making about electing trial/transplant. We gather rich descriptive patient perceptions about their experiences on and with other novel therapies including understanding how these interventions were described by their healthcare teams and the factors that were most influential in rendering their decisions. The study includes two arms: patients who elected trial/transplant and a second cohort of B/AA patients comprised of patients matched for disease state and socioeconomic attributes who did not elect to undergo these interventions. In concert with these qualitative evaluations, we collect and analyze quantitative and categorical data regarding disease response, survival, post-protocol therapies where applicable, and patient reported outcomes including healthcare associated quality of life. We also analyze follow up surveys and a range of patient reported outcomes data collected throughout the patient’s treatment. Data Summary: We examine the impact of critical social and disease-related factors, including income, health insurance status, access to caregiving, understanding of the disease process, initial point of access to the healthcare system, health literacy, and perception of the intervention on the decision to enroll or decline enrollment in clinical trials or undergo ASCT. Conclusion: Our findings examine the mechanisms behind patient enrollment in clinical trials/transplant. B/AA patients comprise only 4% of enrollees in large MM trials worldwide. Many studies have also demonstrated that B/AA patients are less likely to undergo ASCT and are more likely to do so later in their disease course. Furthermore, a study conducted in the Veterans Affairs health system showed that with equal access to care for MM, B/AA patients actually have superior overall survival as compared to their white counterparts. We focus on patient’s complex decision making process, to provide better care and expand diverse research on MM. Study implications include improving equity in MM care for B/AA patients. Citation Format: Louis Williams, Heathe M. Hurwitz, Tiffany Onger, Diana Basali. Critical factors influencing clinical trial enrollment and autologous stem cell transplantation in African-American patients with multiple myeloma: A retrospective, interview-based analysis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A063.