Changing Care Journey for Patients with Multiple Myeloma in the United States

BACKGROUND Management of the hematologic malignancy multiple myeloma (MM) requires a sequence of treatment decisions across the course of the disease to extend survival and maximize quality of life (QoL). With the introduction of novel and increasingly effective therapies and the consequent evolution of treatment paradigms, these decisions have become more complex and personalized. This study aimed to explore how patients living with MM are navigating a rapidly changing care journey. METHODS A non-interventional, qualitative study was conducted in adult patients with MM in the United States. Individuals were recruited through the Gryt Health Cancer Community and social media. Data collection centered on a virtual semi-structured interview. Participants were assigned to a group based on refractoriness to at least one proteasome inhibitor, immunomodulatory drug, and/or anti-CD38 monoclonal antibody (non-refractory; single or double refractory; triple refractory). Qualitative data were coded and analyzed for salient themes. This study was reviewed and approved by an Institutional Review Board. RESULTS Thirty-two participants (12 non-refractory; 10 single or double refractory; 10 triple refractory) completed the study (Table). Participants were diagnosed between 1998 and 2021 (median: 2017); 38% had been diagnosed within the past 5 years. Data related to the care journey clustered around four key environments: treatment, healthcare, social/cultural, and personal factors (Figure). Important shifts were observed in the treatment environment. Notably, 34% (N = 11) of participants were currently off treatment (5 non-refractory; 1 double refractory; 5 triple refractory). Participants with double and triple refractory disease had chimeric antigen receptor (CAR) T-cell therapy-induced remission; however, those with non-refractory disease were off maintenance therapy stating they wanted relief from treatment toxicities and ‘to give my body a break’. This suggests that patients and physicians are attaching increased importance to QoL in making treatment decisions. Within the healthcare environment, participants discussed sites of care and who was delivering care. At least 75% of participants had received care and/or treatment from a National Cancer Institute (NCI)-designated cancer center at some point since diagnosis. Participants with non-refractory disease were least likely to have interacted with an NCI-designated cancer center. Nearly all participants had received