Perspectives of Pediatric Oncologists on Referral for CAR-T Therapy: a Mixed Methods Pilot Study.
Journal
JNCI cancer spectrum
ISSN: 2515-5091
Titre abrégé: JNCI Cancer Spectr
Pays: England
ID NLM: 101721827
Informations de publication
Date de publication:
30 Jul 2024
30 Jul 2024
Historique:
received:
15
05
2024
revised:
09
07
2024
accepted:
26
07
2024
medline:
30
7
2024
pubmed:
30
7
2024
entrez:
30
7
2024
Statut:
aheadofprint
Résumé
Receipt of CAR-T at a different institution is a complex, multi-step process; referral by oncologists plays an important role in the process but may be susceptible to bias. Oncologists who previously referred patients for CAR-T at five pediatric hospitals were emailed surveys exploring their CAR-T referral practices. Descriptive statistics were performed, and multivariate analyses examined associations between oncologist characteristics, familiarity with CAR-T, and referral practices. We conducted semi-structured interviews with a subset of participants and used thematic analysis to code transcripts. Sixty-eight oncologists completed the survey, of whom 77% (n = 44) expressed being 'very familiar' with CAR-T. Hispanic oncologists and those at institutions with ≤50 new diagnoses per year were more likely to identify as less familiar with CAR-T (OR 64.3 (CI: 2.45-10452.5), p = 0.04 and OR 24.5 (CI: 3.3-317.3), p = 0.005, respectively). Thirty-eight percent considered non-clinical features (compliance, social support, resources, insurance, language, education, and race or ethnicity) influential in referral decisions. Oncologists who were Hispanic and those practicing for 20+ years were more likely to consider these features significantly influential (OR 14.52 (CI: 1.49-358.66), p = 0.04 and OR 6.76 (CI: 1.18-50.5), p = 0.04). Nine oncologists completed in depth interviews; common themes included barriers and concerns regarding CAR-T referral, the value of an established relationship with CAR-T center, and poor communication after CAR-T. Nearly 40% of oncologists consider non-clinical features significantly influential when deciding to refer patients for CAR-T, raising concern for bias in the referral process. Establishing formal partnerships with CAR-T centers may help address physician barriers in referral.
Sections du résumé
BACKGROUND
BACKGROUND
Receipt of CAR-T at a different institution is a complex, multi-step process; referral by oncologists plays an important role in the process but may be susceptible to bias.
METHODS
METHODS
Oncologists who previously referred patients for CAR-T at five pediatric hospitals were emailed surveys exploring their CAR-T referral practices. Descriptive statistics were performed, and multivariate analyses examined associations between oncologist characteristics, familiarity with CAR-T, and referral practices. We conducted semi-structured interviews with a subset of participants and used thematic analysis to code transcripts.
RESULTS
RESULTS
Sixty-eight oncologists completed the survey, of whom 77% (n = 44) expressed being 'very familiar' with CAR-T. Hispanic oncologists and those at institutions with ≤50 new diagnoses per year were more likely to identify as less familiar with CAR-T (OR 64.3 (CI: 2.45-10452.5), p = 0.04 and OR 24.5 (CI: 3.3-317.3), p = 0.005, respectively). Thirty-eight percent considered non-clinical features (compliance, social support, resources, insurance, language, education, and race or ethnicity) influential in referral decisions. Oncologists who were Hispanic and those practicing for 20+ years were more likely to consider these features significantly influential (OR 14.52 (CI: 1.49-358.66), p = 0.04 and OR 6.76 (CI: 1.18-50.5), p = 0.04). Nine oncologists completed in depth interviews; common themes included barriers and concerns regarding CAR-T referral, the value of an established relationship with CAR-T center, and poor communication after CAR-T.
CONCLUSIONS
CONCLUSIONS
Nearly 40% of oncologists consider non-clinical features significantly influential when deciding to refer patients for CAR-T, raising concern for bias in the referral process. Establishing formal partnerships with CAR-T centers may help address physician barriers in referral.
Identifiants
pubmed: 39078720
pii: 7724119
doi: 10.1093/jncics/pkae063
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2024. Published by Oxford University Press.