Barriers and solutions in cross-sector care for metastatic prostate cancer patients in Germany: a qualitative study on radioligand therapy

In December 2022, Pluvicto® (lutetium(177Lu)-vipivotide tetraxetan) received European Medicine Agency approval based on the Phase III VISION study as the first radioligand therapy (RLT) directed against prostate-specific membrane antigen (PSMA) and using Lutetium-177 (177Lu) for the treatment of metastatic prostate cancer. The objective of this study was to explore current barriers to the provision of 177Lu-PSMA RLT by drawing on the experiences of providers and to outline potential solutions. Eighteen physicians involved in the care of metastatic prostate cancer in the outpatient and inpatient settings from different regions of Germany participated in this semi-structured, qualitative expert interview study. Qualitative content analysis with inductive category formation was used to analyze the data. Four major thematic categories were identified regarding barriers to care: (a) research-practice gap, (b) challenges to interprofessional collaboration, (c) resource constraints, and (d) unwarranted variation in care. Expert suggestions for resolving these barriers were grouped into the corresponding major thematic categories: (a) knowledge management, (b) integration of care, (c) capacity planning, and (d) facilitation of access. The delivery of 177Lu-PSMA RLT faces several obstacles, including challenges in collaboration, resource allocation, and reimbursement solutions. Minimizing bureaucratic hurdles in forming healthcare teams is essential to enhance interprofessional coordination. Resources should be evaluated and distributed based on local needs, and expanding reimbursement options for prior diagnostics is critical to ensure early treatment access. Overcoming these barriers and adapting health systems to novel therapies like RLT are essential steps toward improving cancer care and patient outcomes.