Outreach effort increases stem cell transplant referrals, may reduce racial disparities
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SALT LAKE CITY — Academic center outreach to community practices considerably increased stem cell transplant referrals for patients with multiple myeloma, according to study results.
The approach resulted in a significant increase in the number of Black patients who underwent transplant, findings presented at Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR showed.
This suggests outreach efforts like this could reduce racial disparities in transplant receipt, researcher Vamsi Kota, MD, director of the bone marrow and stem cell transplantation program at Georgia Cancer Center at Augusta University, and colleagues concluded.
“The biggest barrier for transplant is referrals. Community oncologists have different perceptions than transplant physicians, and the only way to overcome that is to communicate with them and be with them,” Kota told Healio. “The common thinking has been that the community should refer to us. We turned it around and said, ‘We’ll partner with you and work together to change how things are done.’”
Background and methodology
Stem cell transplant confers a survival benefit to patients with multiple myeloma, but referral to transplant centers remains a barrier.
Racial disparities have been documented. The transplant rate for Black individuals with multiple myeloma is approximately 20%, compared with about 39% for white individuals, Kota said.
“That is a tremendous disservice,” Kota told Healio. “Both rates have to improve, but even more so in the Black population.”
In 2018, Georgia Cancer Center initiated a year-long outreach program through which the institution’s physicians visited all practices within its catchment area and participated in patient visits.
“When we are in front of them, patients are more likely to discuss certain things directly with us rather than talking to a nontransplant clinician first and then coming to us with preformed opinions,” Kota said.
The effort — which focused primarily on Athens and Columbia — also included the creation of two outreach clinics in collaboration with large community practice sites.
Kota and colleagues reviewed all autologous and allogeneic stem cell transplants performed at the institution between 2015 and 2021.
They divided patients into two cohorts. Cohort A included patients who underwent transplant between 2014-2017. Cohort B included patients who underwent transplant between 2019-2021, after initiation of the outreach program.
Findings
Results showed 389 transplants performed during the study period, with a significantly higher number performed in 2019-2021 than 2014-2017 (266 vs. 123).
“We’re up from about 40 transplants a year to 110 transplants a year in just over 3 years,” Kota said. “Even during the COVID-19 pandemic, we were able to grow that number.”
Researchers reported a 147% increase in transplants among Black patients during the study period, and a 96% increase in transplants among white patients. This finding suggests greater reach to underrepresented minority individuals, Kota said.
Median distance that transplant recipients traveled to Augusta University more than tripled during the study period, increasing from 15.2 miles in 2014-2017 to 52.3 miles in 2019-2021. The median distance Black patients traveled increased from 15.2 miles to 34.8 miles (P = .0002), and the median distance white patients traveled increased from 15.4 miles to 69.3 miles.
Next steps
The outreach program is expected to expand to include areas around Macon and Savannah, allowing for coverage in a large portion of western South Carolina and eastern Georgia, a region where health outcomes tend to vary widely based on race and socioeconomic status.
Kota projected the cancer center will be performing 150 transplants per year within the next 2 years, nearly four times as many as before the outreach effort began.
“This shows the benefits of us making the effort to partner with community oncologists,” Kota told Healio. “This is an easily reproducible concept.”
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Kota V, et al. LBA 13. Presented at: Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR; April 23-26, 2022; Salt Lake City.
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