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A study led by UNC Lineberger Comprehensive Cancer Center researchers and colleagues found several barriers to high-quality cancer care for people with multiple myeloma and their caregivers. These barriers were more pronounced for study participants residing in communities with high social vulnerability, including high poverty levels and transportation barriers.

Headshot of Shakira Grant
UNC Lineberger’s Shakira Grant, MBBS.

UNC Lineberger’s Shakira Grant, MBBS, the study’s principal investigator, shared the studies’ findings during an oral presentation at the annual meeting of the American Society of Hematology (ASH) in New Orleans on Dec. 10.

“We chose to study outcomes in multiple myeloma because it is a disease where we see some of the greatest Black-white differences in survival, which are largely driven by differential access to care. Despite this knowledge, very few studies have attempted to gain a deeper understanding of the complex factors that underlie these differences in access to care,” said Grant, assistant professor of medicine in the Division of Hematology at the UNC School of Medicine.

Identifying barriers to health care

The researchers focused on 21 pairs, or dyads, of an older adult patient with multiple myeloma who lived in North Carolina and their informal caregiver, who was usually an intimate partner. The investigators conducted semi-structured 60 to 90 minute videoconference interviews with each dyad, allowing for a deep exploration of health care access barriers. The patients were recruited between November 2021 and April 2022 from the North Carolina Basnight Cancer Hospital, UNC Lineberger’s clinical home, and could be in any phase of their disease.

The researchers identified several barriers to health care:

  • Accessibility and transportation, including getting to the cancer center due to lengthy travel times, especially for those living in rural areas far away from the cancer center
  • Concerns and worries about their financial future
  • Delays in making the multiple myeloma diagnosis
  • Delayed referrals to a hematology/oncology specialist
  • Clinic appointment scheduling barriers, including timing and frequency of cancer center visits.

“This finding supports a need for more targeted efforts to support those considered most vulnerable, including enhanced community transportation assistance programs, access to financial navigators, and improved appointment scheduling,” Grant said. “We hope that our study will jump-start efforts to reduce the barriers that limit access to high-quality care for vulnerable populations.”

Authors and disclosures

In addition to Grant, the other authors of the abstract are Jiona Mills, Paul Mihas, MA, Lauren Bates-Fraser, MA, Mykela Moore, Leah Adams, and Hyman B. Muss, MD, UNC; Gabriell Erisnor, City University of New York; and Tanya M. Wildes, MD, University of Nebraska Medical Center, Omaha.

Wildes received consultancy funding from Carevive, Janssen, Seattle Genetics, and Sanofi.

Grant received research funding support from NCI Grant No (5-K12-CA120780-13; PI: William Kim, MD).


172 “…Paying to be a Patient in the Hospital and the Parking Lot”: Dyadic Perspectives on Multiple Myeloma-Related Healthcare Access Barriers