Abstract A091: Improving access and affordability in multiple myeloma care: Patient and provider perspectives

Abstract

Multiple myeloma (MM) is a complex, costly hematologic cancer with well-documented health disparities in patient outcomes. We conducted a qualitative study to capture stakeholders’ perspectives on care barriers and potential solutions to inform interventions that improve accessibility and affordability, particularly for underserved populations. Semi-structured phone interviews were conducted with MM patients (n=15) and providers/staff (ongoing, n=12) at an NCI-designated comprehensive cancer center. Purposeful sampling ensured inclusion of non-Hispanic Black patients, rural residents, and diverse clinical stakeholders. Interviews exploring treatment experiences, barriers/facilitators to care, and support recommendations were audio recorded, transcribed, and analyzed in NVivo15 using deductive and inductive thematic analysis. Two coders independently coded each transcript and resolved discrepancies through consensus. Emerging themes were finalized by study team consensus. Patient participants (mean age 65.3, range 45-61 years; 60% male, 27% Black, 33% rural) all had insurance, though many experienced disruptions due to employment changes. Providers included social workers (n=4), nurse practitioners (n=3), nurse coordinators (n=4), and hospital administrator (n=1). Transportation and proximity to care facilities were primary concerns. Many patients were unable to drive themselves to visits, requiring support from spouses, family/friends, and community members. Rural patients traveled several hours to see their providers due to limited options for local specialist or expert MM care. Also, demanding therapies like CAR-T required extensive caregiver support, excluding patients lacking a support network. Patients also experienced financial burden due to high co-pays and medication costs. Copay assistance programs, insurance coverage, and stable income were essential to increasing affordability of care. Many patients expressed desires for earlier and clearer guidance on resources for financial aid and some suggested implementing dedicated MM patient navigators. Providers/staff emphasized a critical disconnect; patients often do not self-disclose financial or logistical distress during clinical encounters, possibly due to stigma or prioritizing medical discussions. Although clinical stakeholders universally agreed that oncology social workers should proactively screen all patients at intake, staffing shortage restricts their capacity. Consequently, social work involvement is often reactive, triggered only when a patient reaches an acute financial or logistical crisis that threatens treatment adherence. Care facilities can mitigate patient burden through early, proactive needs assessment at diagnosis, enhanced resource navigation, and robust support service integration. Social work is vital to these efforts, but staffing shortages currently limit their capacity and reach. To improve MM health disparities, future efforts should focus on these areas to enhance MM care accessibility and affordability. Meera Muthukrishnan, Shelbie Fishman, Ravi Vij, Michael Slade, Dionne Stalling, Aimee S. James, Mengmeng Ji, Mark Fiala, Su-Hsin Chang. Improving access and affordability in multiple myeloma care: Patient and provider perspectives [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A091.