Barriers in Accessing Myeloma Care in Special Populations | Shakira Grant, MBBS | ASCO 2023

Hi, I'm Dr. Grant, and I'm from the University of North Carolina at Chapel Hill. I'm a geriatric hematologist and oncologist. And this year at ASCO, I was part of the educational session on managing multiple myeloma in special populations. During the session, we heard from not only myself, but also from Dr. Sikander Alawadi, who is based at the Mayo Clinic in Florida, as well as Dr. Claudio Circhioni, who's based in Italy. Both of these presenters, along with myself, focused on special populations. In my talk, I focused primarily on older adults with multiple myeloma, and we sought to examine some of the barriers that this population experiences when it comes to accessing care for multiple myeloma. I highlighted the influence of ageism, which is discrimination on patients based on age alone, as well as how this may intersect with other factors such as racism, which we defined as thinking about the totality of structures and policies that may keep marginalized groups at the margins. We examined and heard from patients directly involved in qualitative research, which is on being underway at the University of North Carolina, and we learned from them in particular about their perspective about the care experiences as it relates to multiple myeloma. I additionally focused on geriatric assessments and the role that they play as we think about ways in which we can assess the functional status of patients and to determine and help us determine the types of treatments that we should be offering for multiple myeloma. In addition as a follow-up to this, while my presentation focused on the older adult, we then learned from Dr. Alawadi about how racism, particularly looking at racial disparities, how that may play a role. Dr. Alawadi reviewed several pivotal trials which showed the disparities that exist, especially within the African American or Black community and Hispanic communities that live with multiple myeloma. The key takeaway from this talk is that while we have had several advances in therapies for multiple myeloma, there is still a lot of work to be done to help close these gaps. Next we heard from Dr. Circhioni. He focused on a special population that we don't often think about, and that is the adult with myeloma who also has chronic kidney disease or kidney impairment. We learned about different strategies in which we need to consider adjusting the doses of our treatments for myeloma, as well as thinking about ways in which we can effectively care for these patients who have kidney disease at presentation. In all, this session focused on special populations with a goal of stating that we did not want to leave any patient with myeloma behind. As a key takeaway from all three of these presentations, we emphasized that when caring for adults with multiple myeloma, we need to consider more than just the disease itself. We need to consider aging-related factors, as well as additional factors such as ageism and racism. We need to also think about potential barriers in access to care and think about strategies for us to be able to effectively address these. Until we are able to incorporate all of these aspects into the care of adults with multiple myeloma, this will forever limit our ability to accumulate, this will forever limit our ability to achieve health equity in multiple myeloma. Thank you.