Access to potentially life-saving CAR T-cell therapy is significantly impacted by geographic location and socioeconomic factors, according to recent research. The study, published in Transplantation and Cellular Therapy, found that patients living farther from treatment centers and those with lower incomes or belonging to certain racial groups are less likely to receive this advanced cancer therapy. These findings highlight critical disparities in healthcare access and the need for strategies to address these barriers.
Distance Matters: The Impact of Travel Time
The study, analyzing data from over 5,000 patients eligible for CAR T-cell therapy, revealed that patients residing 2 to 4 hours away from the nearest treatment center were nearly 40% less likely to receive the therapy compared to those living within 30 minutes. "We mapped the distance, and it turned out that if you live 2 to 4 hours away from a transplant or therapy center, you are way less likely than if you live closer," said Dr. Usama Gergis, professor of medical oncology at Thomas Jefferson University.
This geographic disparity is compounded by insurance restrictions, where some patients are required to travel to in-state facilities, even if a closer option exists across state lines. This can lead to significant delays and added burden for patients already dealing with the challenges of cancer treatment.
Socioeconomic Disparities: Age, Race, and Income
The research also identified significant socioeconomic factors influencing access to CAR T-cell therapy. Older patients were less likely to receive the treatment, with the likelihood decreasing by 4% for each year increase in age. Black patients were 56% less likely than White patients to receive the therapy, and patients in the lowest income group were also 56% less likely to receive the treatment compared to the highest income group.
"This study helpfully shines a light on some of the other factors that can influence access to treatment beyond the patient’s distance from a treatment site, including income and race," noted Kolton Gustafson, MPH, principal of policy practice at Avalere Health. These findings underscore the complex interplay of factors affecting healthcare access and the need for targeted interventions to address these disparities.
Reducing the Monitoring Period
Currently, the FDA mandates that patients remain near the treatment center for 4 weeks after CAR T-cell therapy due to the risk of adverse events like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). However, recent research suggests that a shorter monitoring period may be feasible.
A study published in Blood Advances found that among 475 patients infused with axicabtagene ciloleucel, tisagenlecleucel, or lisocabtagene maraleucel, no cases of CRS occurred after 2 weeks, and only one incident of new-onset ICANS appeared in week 3. "A flexible monitoring period may help decrease financial and geographic limitations for patients and make CAR T more accessible and feasible," wrote Dr. Nausheen Ahmed, associate professor at the University of Kansas Cancer Center.
Employer Initiatives and Centers of Excellence
Some employers are taking steps to improve access to specialized cancer care through Centers of Excellence (COEs). For example, Walmart offers its employees access to top specialists and facilities for cancer treatment, covering 100% of eligible costs, including travel and lodging for patients and their companions. These initiatives can help bridge gaps in access and ensure that patients receive high-quality care, regardless of their location or socioeconomic status.
The Patient Perspective
The challenges of accessing CAR T-cell therapy extend beyond logistics and finances. The emotional and practical burdens on patients and their families can be significant. As Sloane Cammock, a clinical trials nurse navigator for the Leukemia & Lymphoma Society, explained, some patients face difficult decisions about relocating for treatment, potentially disrupting their family lives and careers. The intensive nature of CAR T-cell therapy and the potential for adverse events require a significant time commitment from both patients and caregivers.
Addressing these disparities requires a multi-faceted approach, including expanding the availability of treatment centers, reducing the monitoring period, addressing insurance restrictions, and providing financial assistance to patients in need. By working together, healthcare providers, policymakers, and employers can help ensure that all patients have equitable access to this potentially life-saving therapy.
