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Dr Joseph Mikhael: Researchers, Organizations Must Collaborate to Address Disparities in Multiple Myeloma

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Researchers and organizations must collaborate to address the persistent disparities in access to treatments for multiple myeloma, explained Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation.

Researchers and organizations must collaborate to address the persistent disparities in access to treatments for multiple myeloma (MM), explained Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation.

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How are patients from underrepresented groups affected by access issues when seeking treatment for MM?

This is an area that we're really trying to understand better, but I think we've seen—whether it's myeloma or lymphoma or leukemia—we know that one of the greatest disparities in access has been a socioeconomic one, where less than 5% of patients who have received a CAR [chimeric antigen receptor] T-cell therapy have a household income of less than $50,000. And so, this is a grave problem, and we don't want this to be a therapy that's only accessible to a certain demographic because we know that just like these diseases affect all demographics, we want to bring treatments that affect all demographics.

I do think it's very important that we look at this issue and find ways to solve it. I think, as noted, many of the potential solutions include being very cognizant of this disparity [and] that there is a historical mistrust in the health care system, that systemic racism affects our health care system, that specific insurance—having limited insurance for patients on Medicaid, for example, or the uninsured, for these kinds of treatments—further widens that disparity. So we need a comprehensive effort that looks at the regulatory standpoint, the industry standpoint, the health care provider standpoint, and indeed a social component for us to look at and find very creative ways to ensure that these great therapies are accessible to all patients who would be eligible for them.

How can researchers and organizations collaborate to increase recruitment and participation of underrepresented populations in MM clinical trials?

I think the key word there is to collaborate. There has to be a collaboration—I think too often, we've worked too much in isolation. I think we're at a stage in the greater process of recognizing the magnitude of the problem. And so admitting the problem is the first step, but looking at how each individual group or organization has a role to play, and being willing to work together, being a little bit more creative in saying, "Let's get our advocacy organizations at the forefront," [and] bringing individuals together and groups together to say, "How are we going to do this?"

It's not just about setting a target and saying, "Thou shalt have 10% of your patients from this background or that background." It's about saying, "How do we ensure that this is sustainable in the long term? How do we meet those targets?" Not because there's an artificial number, but because we want the best for each of these communities. How do we engage those communities so that they can see and understand that we have their best at heart? How can we train our health care providers at all levels—physicians, nurse practitioners, physician assistants, pharmacists, social workers—all to ensure that we work cohesively together to provide these options to patients that are best for them? How do we work with the industry to make sure that the right sites are represented? Why should we keep doing the same clinical trials in the same centers? We need to be more diverse in our geographical choice. So it really does require a collaborative effort for all, and I think it's very feasible. I think it is very doable with the interest, with the commitment, and the resources we have in this country, to do so.

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