Few patients who received chimeric antigen receptor (CAR) T-cell therapy were from low-income neighborhoods, particularly if those neighborhoods were located further than 10 miles away from the administering center, according to results of a retrospective study presented at the 2022 Tandem Meetings.
Although CAR-T therapy is potentially curative for patients with relapsed/refractory non-Hodgkin lymphoma, there are stringent residency and caregiver requirements after undergoing treatment to help mitigate toxicities that can be fatal, such as cytokine release syndrome and neurotoxicity.
“We hypothesized that the out-of-pocket expenses and caregiver restraints associated with travel and local lodging requirement limit access to CAR-T for patients from lower socioeconomic class,” the authors said in their presentation.
The study authors analyzed data from elective admissions for CAR-T therapy or other reasons unrelated to CAR-T therapy between 2018 and 2020 from the Vizient CDB database. Neighborhood income status was determined using census data and low income was categorized as neighborhoods with a median household income of less than $40,000.
There were 81 centers that administered CAR-T therapy. Patients who received CAR-T were more likely to live at least 10 miles away from the center compared with non-CAR-T therapy admissions, with 42% and 38%, respectively, coming from 10-59 miles away and 38% and 15%, respectively, coming from more than 60 miles away (P <.0001).
Among patients who received CAR-T therapy, 11.8% were from a low-income neighborhood, with many of these patients living within 10 miles of the administering center. Compared with other racial/ethnic groups, African Americans were 2 times less likely to receive CAR-T therapy. Patients with Medicaid insurance or who were uninsured were also less likely to receive CAR-T therapies.
The authors concluded that “a considerable disparity exists in access to CAR-T based on socioeconomic status.” They added that “strategies to improve access need to be framed around understanding and addressing these disparities.”
Shahzad M, Faisal MS, Shippey E, et al. Socioeconomic and racial barriers to CD19 chimeric antigen receptor T cell therapy (CART) access. Presented at: 2022 Tandem Meetings; April 23-26, 2022. Abstract 256.