Barriers to and facilitators of clinical trial participation in multiple myeloma

1 Key barriers to multiple myeloma clinical trial participation were identified, and country-specific recommendations are provided. 2 Findings will advance the field and can form the basis of a framework that informs the optimal implementation of recommendations. Therapies for multiple myeloma (MM) have advanced; however, disparity in healthcare outcomes remains. Barriers to clinical trial enrollment contribute to this disparity and result in recruiting unrepresentative groups of patients, depriving patients of opportunities to benefit from experimental treatments, and causing incompletion of some trials due to insufficient accrual rates. This study aimed to identify geographic inequalities in clinical trial participation and develop a comprehensive list of barriers (factors preventing participation) to and facilitators (factors enabling improvements) of patient enrollment in MM clinical trials. Geographic data were collected for MM trials registered between 2011 and 2021 to determine the number of trials and recruitment rates in different regions. Of the trials identified, 61% recruited patients from the US; 24%, 14%, and 13% recruited patients from Western Europe, Southern Europe, and Eastern Asia, respectively. Other geographic regions were less involved in MM clinical trials, highlighting global inequality in MM clinical research. Barriers to and facilitators of patient enrollment in MM trials were identified through a systematic literature review and broadly categorized into 4 domains: clinical (eg, eligibility criteria), patient specific (eg, socioeconomics), physician specific (eg, awareness of trials), and structural (eg, regulatory environment). These domains were presented to stakeholders, who were from various backgrounds and geographic regions, to ascertain which were most relevant to patients with MM globally. Recommendations were identified, with unanimous support from interviewees, and have the most potential for global application. The application of these findings will help overcome the many barriers to enrollment in MM clinical trials.