Roundtable on Black in cancer research and oncology

Brandon Blue, Kilan Ashad-Bishop, Onyinye and Folu Balogun and Runcie C.W. Chidebe

Slide at 07:22

$MOFFITT Understanding Physician Referral for Chimeric Antigen Receptor T-C CANCER CENTER Brandon J. Blue, MD, Paige Lake, MPH, Heather Jim, PhD, Frederick Locke, MD, PhD, Susan Vadaparampil, PhD Moffitt Cancer Center & Research Institute Dr. Brandon Blue Introduction Survey Results Survey Results Results Physician primary clinical practice Chimeric Antigen Receptor Therapy is FDA Unaware or have Aware have Total (%) P value We received 67 completed surveys(10% response rate) approved for treatment of relapsed and refractory Practices, perceptions, awareness, and barriers related to CAR T-cell therapy not referred referred and used Of those who completed the survey: Diffuse Large B-Cell Lymphoma. Unaware or have not Aware have referred Total (%) value as part of referred and used as part of practice/clinical 86% did not practice at an NCI-designated cancer Whether While this therapy is valuable, the high cost practice/clinical center. training raising concerns for patient access, and little is training Which of the following Which of the following describes your primary known about Oncology physicians' knowledge, types of patients do you clinical specialty? Study responses were examined by comparing 2 attitude, and referral patterns. treat? Medical oncology only 5(7.6) 5(7.6) groups: those who are aware of CAR-T and refer(57%) Diffuse large cell 9(28.4) 38 (56.7) 57 (85.1) 0.001 Medical 17(25.8) 22 (33.3) 39 (59.1) vs. those who are unaware and do not refer(47%). To fill this gap, we conducted a study of Florida lymphoma oncology/Hematology based oncologists. Transformed follicular 17 (25.4) 36 (53.7) 53 (79.1) 0.001 Medical 4(6.1) 16 (24.2) 20 (30.3) lymphoma oncology/Malignant Significant differences noticed between the 2 groups Primary mediastinal B (22.4) 33(49.3) (71.6) 0.002 Hematology such as: cell lymphoma Other (3.0) 2(3.0) Never discussing CAR-T with newly diagnosed patients Purpose Large cell lymphoma 19(28.4) 35 (52.2) 54 (80.6) 0.01 0.002 (36% vs. 26% p<0.05) Acute lymphoblastic 4 (6.0) 19 (28.4) (34.3) 0.002 Which of the following leukemia describes the practice or None of the above To identify potential gaps in oncologists' attitudes, 10(14.9) (14.9) 0.001 setting in which you work Discussion of CAR-T with relapsed/refractory patients the most hours per week? knowledge, and referral patterns for chimeric antigen Do you, or does your (47% vs. 13% p<0.001) receptor t-cell therapy in patients with Diffuse Large B- center/practice, offer FDA- Academic oncology (7.6) 8 (12.1) (19.7) Cell Lymphoma in the Moffitt catchment area and approved CD19 CAR T-cell group therapies (Yescarta and Presence of CAR-T patient education materials (18% across the state of Florida. Community oncology (28.8) 27 (40.9) 46 (69.7) Kymriah)? vs. 3% p<0.05) 8 (12.5%) (10.9%) group 15(23.4) Other 4(6.1) 3(4.5) 7(10.6) 19(29.7%) 29(45.3%) 48(75) 0.74 Unsure 1(1.6%) 1(1.6) Significant differences observed in knowledge of Do you practice at an NCI. 0.30 indication for CAR-T therapy (58% vs. 24% p<0.01) designated cancer center? 517.7) 4 (6.2) 9(13.8) 23(35.4) 33 (50.8) 66(86.2) Methods Provider confidence was lower among those who were Survey Results Unsure unaware 12% vs. 1% p<0.01 0.48 Please indicate how confident you are in your understanding of the following topics: Which of the following The American Medical Association Masterfile Unaware or Aware have Total p value best characterizes your have not referred and database was used to identify 771 practicing practice? referred used part of hematology and medical oncologists. We then mailed practice/clinical Conclusions Oncology/Hematology (30.3) 28 (42.4) 48(72.7) survey packets to these 771 Florida oncologists and training specialty practice Efficacy of CAR T-cell therapy hematologists Survey packets contained a paper Multispecialty 6(9.1) 10(15.2) 16(24.2) Completely confident & Fairly confident This is the first study, to our knowledge, to assess 11 (16.9) 21 (32.3) 32(49.2) Other survey and the URL for a web-based version, a 2(3.0) 2(3.0) Somewhat confident 9(13.8) 14(21.5) 23(35.4) 0.32 oncologist attitudes, knowledge, and referral response postcard to complete and send back to us Not at all confident & Slightly confident 7(10.8) 3(4.6) 10(15.4) patterns for lymphoma patients with CAR-T. indicating their willingness to participate, and a letter 0.15 Toxicity of CAR -cell therapy Overall, there was a difference in referral patterns describing our study. We conducted three mailing Completely confident & Fairly confident 11 (16.9) 24 (36.9) 35 (53.8) for CAR-T based on provider knowledge, waves for physicians who did not complete our survey Somewhat confident 8(12.3) 11 (16.9) 19(29.2) confidence, and communication Efforts are after the first mailing or indicate via the response Not at all confident & Slightly confident 8(12.3) 3 (4.6) 11(16.9) needed to educate oncologists about CAR-T, postcard that they did not wish to participate. We 0.06 Timing for CAR cell referral which will improve provider confidence and received 67 survey responses. Physicians were given Completely confident & Fairly confident 9(13.8) 21 (32.3) 30 (46.2) referral patterns. the option to complete the survey via paper or a web Somewhat confident 10(15.4) 16(24.6) 26(40.0) link; 50 completed the paper version and 17 Not at all confident & Slightly confident 8(12.3) 1 (1.5) 9(13.8) 0.007 completed the web version. After excluding Indications for CAR -cell therapy undeliverable surveys (n=123), our response rate was Completely confident & Fairly confident 13(20.0) 26(40.0) 39 (60.0) 10% (67/648 Somewhat confident 6(9.2) 11 (16.9) 17(26.2) Not at all confident & Slightly confident 8(12.3) 1 (1.5) 9(13.8) 0.008 Managing late side effects/symptoms for patients following CAR T-cell therapy Completely confident & Fairly confident 6(9.2) 14(21.5) 20 (30.8) Somewhat confident 6(9.2) 11 (16.9) 17 (26.2) Not at all confident & Slightly confident 15(23.1) 13 (20.0) (43.1) 0.26$

References

1.
B. J. Blue et al. (2022) Understanding Physician Referral for Chimeric Antigen Receptor T-Cell Therapy. Transplantation and Cellular Therapy

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Summary (AI generated)

So, I can understand how being a local oncologist, if you are not experienced in providing care for patients after undergoing complex therapy, it might make you feel hesitant to make referrals. Unfortunately, certain communities were impacted more by this lack of access. Specifically, minority communities did not have the means to reach these large academic centers independently. It is crucial for us to acknowledge this fact in terms of clinical trials as well.