肿瘤细胞治疗研究
英文原题：Access to T-Cell Redirecting Therapies in Multiple Myeloma: Patient, Caregiver, and Physician Perspectives on Awareness and Barriers.
结果：共有428名受访者参与（346名患者、51名照护者、31名医生）。
背景：T细胞重定向疗法（TCRTs），包括CAR T细胞疗法和双特异性抗体，已改变复发/难治性多发性骨髓瘤（MM）的治疗格局，然而在患者、照护者和医生中，认知和可及性障碍仍限制了其在真实世界中的采用。 方法：我们开展了一项横断面研究（2025年6月至9月），使用经IRB批准的REDCap调查问卷，通过MyChart分发给MM患者，通过电子邮件分发给TCRT接受者的照护者，以及通过电子邮件分发给社区医生。调查评估了TCRT熟悉度、感知障碍和可及性挑战。主要目标是比较既往接受过治疗的患者中不同种族群体的TCRT使用情况。 结果：共有428名受访者参与（346名患者、51名照护者、31名医生）。在患者中，18%为黑人。总体而言，26%对TCRT不熟悉，其中黑人患者（32% vs. 25%）和高中教育程度者（42% vs. 23%）的不知晓率更高。较高教育程度与TCRT使用几率增加两倍相关（p = 0.05）。在报告既往接受过MM治疗的患者中，TCRT使用情况在不同种族群体间相似（黑人39% vs. 非黑人38%）。在报告接受过TCRT的患者中，黑人患者比非黑人患者更常报告通过临床试验接受治疗（44% vs. 34%）。在照护者中，53%报告对心理/情绪健康产生影响，61%报告治疗期间存在中度至高度压力，33%在第一个月每周提供>40小时的照护。在医生中，71%曾转诊患者接受TCRT，但48%报告<25%的转诊最终实现了治疗。患者犹豫是最常被提及的转诊障碍。结论：认知差距对黑人患者和受教育程度较低者的影响尤为严重。照护者承受着巨大的情感和时间负担。患者犹豫仍是TCRT转诊的主要障碍。临床试验可能成为部分患者的替代获取途径。需要针对教育、照护者支持和护理协调的多层面干预措施，以改善TCRT的公平可及性。
Background : T-cell redirecting therapies (TCRTs), including CAR T-cell therapies and bispecific antibodies, have transformed treatment for relapsed/refractory multiple myeloma (MM), yet real-world adoption remains limited by awareness and access barriers across patients, caregivers, and physicians. Methods : We conducted a cross-sectional study (June-September 2025) using IRB-approved REDCap surveys distributed to patients with MM (via MyChart), caregivers of TCRT recipients (via email), and community physicians (via email). Surveys assessed TCRT familiarity, perceived barriers, and access challenges. The primary objective was to compare TCRT utilization across racial groups among previously treated patients. Results : A total of 428 respondents participated (346 patients, 51 caregivers, 31 physicians). Among patients, 18% were Black. Overall, 26% were unfamiliar with TCRT, with higher unawareness among Black patients (32% vs. 25%) and those with high school education (42% vs. 23%). Higher education was associated with twice the odds of TCRT utilization ( p = 0.05). Among patients reporting prior MM treatment, TCRT utilization was similar across racial groups (39% Black vs. 38% non-Black). Among patients reporting TCRT receipt, Black patients more frequently reported receiving therapy through clinical trials compared with non-Black patients (44% vs. 34%). Among caregivers, 53% reported effects on mental/emotional wellness, 61% moderate-to-high stress during treatment, and 33% provided >40 h/week of care during month one. Among physicians, 71% referred patients for TCRT, but 48% reported <25% of referrals resulted in treatment. Patient hesitancy was the most cited referral barrier. Conclusions : Awareness gaps disproportionately affect Black patients and those with lower education. Caregivers experience substantial emotional and time burden. Patient hesitancy remains the primary barrier to TCRT referrals. Clinical trials may serve as an alternative access pathway for some patients. Multi-level interventions targeting education, caregiver support, and care coordination are needed to improve equitable TCRT access.
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