A Multistakeholder Qualitative Analysis of Barriers to Autologous Stem Cell Transplantation for Multiple Myeloma

We investigated autologous stem cell transplantation (ASCT) barriers in a single-center qualitative study by interviewing patients with multiple myeloma (MM), transplant physicians (TPs), and referring physicians (RPs).

Patients with MM and referred for ASCT evaluation between January 01, 2021 and December 31, 2022, TPs from 2 Wisconsin transplant centers, and RPs from rural and urban Wisconsin were recruited. Interviews were conducted using a semi-structured interview guide focused on ASCT barriers. Transcripts were double-coded and reviewed. An initial codebook with prespecified themes based on the interview guide was developed and iteratively revised.

Eighteen patients, 5 TPs, and 4 RPs were interviewed. Four major ASCT barriers themes were identified across all stakeholders: caregiver support, patient concerns and knowledge, financial toxicity, and logistics. Unique themes included social support by patients and ASCT referral by physicians. Lacking caregiver support was more common among single, childless, and socially/geographically isolated patients. Patients were most concerned about side effects, long hospital stays, and quality of life. Patients used online websites and support groups to gain knowledge and support. While most patients experienced financial toxicity, care costs were rarely discussed. Distance from transplant center, transportation, and care coordination were barriers. Referrals from community oncologists are a major barrier. Patients never seen at a transplant center may have the most barriers.

This qualitative study of both patients and physicians investigating barriers to access to ASCT in MM, provides a much-needed multistakeholder perspective. Interventional strategies targeting key barriers will be critical in improving ASCT utilization in MM.