A Pilot Screening and Patient Navigation Program for Early Detection of Multiple Myeloma to Address Cancer Disparities
Authors: Basali Diana , Hurwitz Heather McKee , Bell Kim , Sanders Kimberly , Ribbins Mark , Jackson Raymond , Valent Jason 
Published: December 2024

Introduction:

While there are no universal screening guidelines for the early detection of Multiple Myeloma (MM) or its precursor conditions, Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM), these conditions can easily be detected with a simple blood draw. MM is twice as common and MGUS about three times as common among African American/ Black (AA) persons compared to Caucasian/White persons. AA patients also have a higher risk of delay in initial treatment. Early detection can be beneficial to quality of life, prevention of catastrophic end-organ damage, and lowering time to treatment. We developed a pilot screening program including patient navigation to detect MGUS, SMM, and MM early and aim to understand community reception to the program.

Methods:

Convenience sampling was used and eligibility included those identifying as AA and at least 50 years old. Cleveland Clinic Cancer Institute's Community Outreach Team partnered with community organizations for screenings. Surveys and review of the electronic health records assessed community reception, details of screening implementation within the community, retention of education about MM ,and demographics. Surveys and education materials were conceptualized with input from patients and medical experts.

After receiving education about MM, patients were screened with a single blood draw yielding serum immunofixation, free light chains, and immunoglobulin levels. Patients completed a questionnaire about their attitudes towards screening and education. To describe project implementation, an event evaluation form documented patient enrollment rates and details on why patients declined to enroll. Techniques used to recruit participants and spark interest were also documented.

Results were communicated via phone call and MyChart. Clinicians called with abnormal results and patient navigators scheduled patients for follow-up and addressed socioeconomic barriers. Patients were later called to complete a second questionnaire about knowledge of MM. A progress report was sent to participants with updates on project findings.

Results:

141 individuals participated in the screening at 13 events from 6/2023 to 6/2024. Participants included n=121, 86% female; n=20, 14% male; n=141, 100% Black; and median age=67 [60-73]. Events included 5 community health fairs, 5 dedicated cancer screening events, and 3 community events/festivals such as church events and a walk.

The enrollment rate was 87% (141/162). The most common reasons for declining included dislike in research and dislike in needles.

The most common reasons for participating included interest in any cancer screening (n=76, 54%), MM being more common in AA/black people (n=53, 38%), concern about family history of cancer (n=37, 26%), and trusting the community outreach team (n=29, 21%) (participants could indicate multiple responses).

Participants rated the following questions on a scale of 1 (not at all) to100 (extremely) with mean scores reported. “Is receiving MM screening good for your health?” (94.3), “Did screening take too much time?” (25.4), “Should MM screening be offered widely?” (97.1), “Did screening ease your concerns?” (74.0), “Did screening increase your concerns?” (49.7), “To what degree was it comfortable having blood drawn in the community setting”? (90.2).

While no patients were found to have SMM or MM, results revealed that 12% had MGUS. Notably, 100% of patients with abnormal results flagged were able to follow-up either virtually or in person in clinic due to effective patient navigation.

Conclusion:

We developed a novel approach for early detection of MGUS, SMM, MM for AA. The screening has been well received by the community as it builds on partnerships with community organizations and builds relationships with patient navigation. The project addresses barriers to screening by conducting screenings on-site at community organizations. Results suggest that positive perceptions of screening and multidisciplinary patient navigation ensures adequate patient follow-up. It also highlights that when we actively screen for MM, SMM, and MGUS in a known higher risk population, we may detect higher rates of these conditions than previously reported in the literature.