Activity Zoom Link: https://uky.zoom.us/meeting/register/nSMeypxVRH2CMqh4SWDiEw

Kentucky oncology providers lack established protocols for administering and managing Bispecific Antibody (BsAb) therapy in Multiple Myeloma, necessitating full patient referrals to the University of Kentucky HealthCare. This gap in local capacity creates substantial barriers to patient care in rural Kentucky, a population already facing significant health care disparities.

Kentucky has approximately 41% of its population living in rural areas, ranking it among the states with the highest rural population density in the nation (AHR, 2024). Further, rural cancer patients face well-documented challenges, including greater travel distances to specialty care, financial toxicity from travel and lodging costs, limited access to clinical trials and novel therapies, and higher rates of treatment nonadherence and abandonment (Bhatia, 2022; Yabroff, 2022). These barriers are particularly relevant in therapies requiring frequent administration and intensive monitoring, such as BsAbs, which necessitate weekly or biweekly visits during initial treatment phases and ongoing monitoring for immune-related toxicities.

For patients requiring BsAbs dose escalation followed by ongoing therapy, studies have shown that those living farther from hospitals and traveling more than 50 miles had lower adherence to encoded treatments, poorer prognosis, and poorer quality of life (Ambroggi, 2015).

The following education gaps were identified through a literature review:
Gap 1. Absence of institutional protocols for BsAb administration, toxicity management, and monitoring.
Gap 2. Limited clinician knowledge regarding BsAb mechanisms of action, unique toxicity profiles (CRS, ICANS, infections), and evidence-based management strategies.
Gap 3. Lack of experience with patient selection, shared decision-making, and counseling specific to BsAb therapy.
Gap 4. Insufficient infrastructure for rapid response to BsAb-related emergencies and lack of established escalation pathways.
Gap 5. Absence of systems for ongoing quality monitoring, outcome tracking, and continuous quality improvement for BsAb programs.

The program, Systemic Uptake and Standardization of Treatment Advances Through an Integrated Network (SUSTAIN) for Bispecific Antibody Therapy, will be used to assess the potential of continuing education for community oncology providers to deliver safe and effective BsAb therapy for multiple myeloma patients.