Project CoMMunity: A local learning network deployed to address multiple myeloma care gaps in two communities

Introduction Treatment advances in multiple myeloma (MM) have resulted in five-year survival improvements. However, gaps remain in access and adoption of standard of care (SOC) and novel therapies. As a result, variation in care persists. Project CoMMunity is a multi-center, local learning network to detect unmet needs, understand barriers impacting SOC treatment access, and address care gaps through innovative oncology partnerships and targeted interventions. Materials/Methods A multi-method approach was used to implement an integrated local learning network among academic and community oncology practices within New York City, NY and Winston-Salem, NC. A needs assessment and co-creation session to identify barriers and solutions was performed through community roundtables with diverse stakeholders. Electronic medical record data of patients with MM were compared across communities. Clinician-reported barriers and root causes limiting access and adherence to SOC treatments were solicited through 1:1 interviews. Results Among 12 clinicians and 4 social workers/patient advocates that participated in the roundtables, common barriers were health literacy/socioeconomic factors, limited community/academic clinical relationships, cultural/racial issues and low patient trust, complex patient priorities/medical conditions, and limited clinical trial exposure. Stakeholders indicated opportunities to support education and awareness, improve care continuity transitions among community and academic sites, and development of educational materials. Of 332 patients (NY 237; NC 95), quantitative analysis highlighted clinical variation in time from diagnosis to specialist visit (NY: 34 vs NC: 62 days), frontline therapy (1LOT) count (quadruplet, NY: 62.3% vs NC: 11.6%; triplet, NY: 34.3% vs NC: 79.0%) and stem cell transplantation incidence (NY: 30.8% vs NC: 50.5%). Time from diagnosis to 1LOT and proportion of patients referred to sub-specialists were consistent among sites. Overall, few patients (5.1%) received innovative therapies (eg, CAR-T, bispecific antibodies). Among 10 interviews, clinician-reported barriers and root causes limiting access to SOC treatment included patient characteristics, care barriers, referral/treatment protocols, and community engagement/support resources. Conclusion Local communities vary in needs, capacity, stakeholders, and existing healthcare infrastructure. Programs striving to improve access and adoption of SOC and novel therapies need to be multi-faceted and designed with local implementation in mind. A local learning network with regional participants provides a robust framework to efficiently transfer insights and clinical best practices while deploying local interventions that are responsive to needs of a diverse community. A one size fits all model will not succeed given unique setting and community needs.