Nurse Practitioner MD Anderson Houston, Texas, United States
Introduction: It is a well-known and disturbing fact that racial and ethnic minority populations with multiple myeloma (MM) are often underrepresented, especially in clinical trials. In fact, some studies report less than 4% of patients of African American descent will enroll in therapeutic trials1 and though there is opportunity to receive novel standard of care treatments, minority populations are still underserved. With this knowledge, an international group of MM nursing experts convened in September 2021 to discuss barriers that hinder equitable access to care and provide strategic solutions. Better understanding of diverse populations is critical for nurses and advanced practice providers to effectively provide care.
Methods: In order to identify the prevalent groups impacted by disparity and barriers to equitable treatments, a literature review through PubMed was conducted using the search terms of myeloma, bias, diversity, inequity, clinical trial, sexual orientation, and disparity. A total of 180 articles were identified and from those, 54 were excluded as they did not involve MM patients and 37 were excluded as they did cover disparity in MM.
Results: The search identified key disparities that affect patient access to treatment and care including race, age, socioeconomic status, and sexual preference/orientation. These disparities profoundly affect patient care and the effect of clinical trials, especially as investigational drugs are administered in real world setting. Based on literature review, authors synthesized the information to provide recommendations to better inform the nurse and advanced practice provider of strategies to increase trial participation for diverse populations (Table 1).
Table 1: Gap and Proposed intervention Lack of healthcare provider education regarding existing disparities -Provide ongoing education -Identify and address barriers -Provide resources on diversity and implicit bias Lack of community awareness of clinical trials -Provide clinical trial education directly to communities -Establish relationships to foster trust -Consider logistical challenges for patients Lack of access to clinical trials for rural communities -Develop outreach programs -Utilize local laboratories and facilities to decrease travel burden -Collaborate with sponsors to provide greater financial assistance Lack of inclusivity in clinical trials -Incorporate gender-neutral terminologies through consent and questionnaires
Conclusions: The lack of representation from various ethnic backgrounds in clinical trials ultimately impacts the treatment for all MM patients. Identifying and creating realistic strategies to address barriers to diversity in trial enrollment is a crucial step to advancing equity among MM patients. Based on the review the group developed evidenced based recommendations to equip health care providers to create an equitable therapy plan for MM patients with plans to publish full recommendations in a peer-reviewed journal.
