Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
JNCI Cancer Spectr. 2024 Jul 1;8(4). doi: 10.1093/jncics/pkae063.
Receipt of chimeric antigen receptor T-cell (CAR-T) therapy at an institution different from the primary oncologist's institution is a complex, multistep 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 therapy at 5 pediatric hospitals were sent surveys by email exploring their CAR-T referral practices. Descriptive statistics were generated, and multivariate analyses examined associations among oncologist characteristics, familiarity with CAR-T therapy, and referral practices. We conducted semistructured interviews with a subset of participants and used thematic analysis to code transcripts.
Sixty-eight oncologists completed the survey; 77% expressed being "very familiar" with CAR-T therapy. Hispanic oncologists and oncologists at institutions with 50 or fewer new diagnoses per year were more likely to identify as less familiar with CAR-T therapy (odds ratio [OR] = 64.3, 95% confidence interval [CI] = 2.45 to 10 452.50, P = .04 and OR = 24.5, 95% CI = 3.3 to 317.3, P = .005, respectively). In total, 38% of respondents considered nonclinical features (compliance, social support, resources, insurance, language, education, and race or ethnicity) influential in referral decisions. Oncologists who were Hispanic and oncologists who had been practicing for 20 or more years were more likely to consider these features significantly influential (OR = 14.52, 95% CI = 1.49 to 358.66, P = .04 and OR = 6.76, 95% CI = 1.18 to 50.5, P = .04). Nine oncologists completed in-depth interviews; common themes included barriers and concerns regarding CAR-T therapy referral, the value of an established relationship with a CAR-T therapy center, and poor communication after CAR-T therapy.
Nearly 40% of oncologists consider nonclinical features significantly influential when deciding to refer patients for CAR-T therapy, raising concern for bias in the referral process. Establishing formal partnerships with CAR-T therapy centers may help address physician barriers in referral.
在与主要肿瘤医生所在机构不同的机构接受嵌合抗原受体 T 细胞（CAR-T）治疗是一个复杂的多步骤过程。肿瘤医生的推荐在这个过程中起着重要作用，但可能容易受到偏见的影响。
我们向曾在五家儿科医院推荐患者接受 CAR-T 治疗的肿瘤医生发送电子邮件调查问卷，以了解他们的 CAR-T 推荐实践。我们生成了描述性统计数据，并进行了多变量分析，以研究肿瘤医生特征、对 CAR-T 治疗的熟悉程度与推荐实践之间的关联。我们对一部分参与者进行了半结构化访谈，并使用主题分析对转录本进行编码。
68 名肿瘤医生完成了调查；77%的人表示“非常熟悉”CAR-T 治疗。西班牙裔肿瘤医生和每年新诊断病例数在 50 例以下的肿瘤医生更有可能表示对 CAR-T 治疗不太熟悉（比值比[OR] = 64.3，95%置信区间[CI] = 2.45 至 10452.50，P = .04 和 OR = 24.5，95%CI = 3.3 至 317.3，P = .005）。共有 38%的受访者认为非临床特征（依从性、社会支持、资源、保险、语言、教育以及种族或民族）在推荐决策中具有影响力。西班牙裔肿瘤医生和从业 20 年以上的肿瘤医生更有可能认为这些特征具有显著影响（OR = 14.52，95%CI = 1.49 至 358.66，P = .04 和 OR = 6.76，95%CI = 1.18 至 50.5，P = .04）。9 名肿瘤医生完成了深入访谈；常见主题包括 CAR-T 治疗推荐方面的障碍和顾虑、与 CAR-T 治疗中心建立良好关系的价值，以及 CAR-T 治疗后的沟通不畅。
近 40%的肿瘤医生在决定推荐患者接受 CAR-T 治疗时认为非临床特征具有显著影响，这引发了对推荐过程中存在偏见的担忧。与 CAR-T 治疗中心建立正式合作关系可能有助于解决医生在推荐方面的障碍。
