BETA- How can equitable CAR-T therapy access be increased?

While CAR T-cell therapy is a powerful new option for treating certain blood cancers, not everyone who could benefit from it is able to get it. There are still real challenges like high costs, limited access to treatment centers, complicated travel and scheduling, and a lack of awareness or support, especially in minority and underserved communities. In this Health Tree University lesson, we'll explore the steps being taken to make CAR T-cell therapy more accessible and equitable so that more patients, no matter where they live or who they are, can have a fair chance at this life-changing treatment. How can equitable CAR T therapy access be increased? CAR T has been this amazing development of a complex immune therapy that has the potential to benefit many patients with myeloma. One of the major challenges are that delivery of this care involves close work with a specialized academic center, and these centers who have expertise in safe and effective delivery of CAR T are not uniformly distributed throughout the country. So there are many issues regarding access to care that come up with getting into centers where CAR T can be effectively given. The complexity of the treatment of potential side effects that can come from CAR T require that patients need a caregiver for a certain period of time after delivery of CAR T, as well as may not be able to drive for about two months, and some guidelines after CAR T. So there needs to be a really great support system surrounding the patients, and I think that there are many aspects in which we can try to work on improving equitable access to CAR T. So firstly, knowledge of CAR T, working with empowering patients to know about CAR T as an option and to discuss it with their treating physicians early rather than later can help try to work out facilitating transportation and the logistical ranges of getting to a CAR T center. Additionally, making sure that patients are being considered for CAR T when they have some effective treatment options left available to them is still important, is very important. I think that CAR T and the resources needed to deliver it both in the hospital and then in the post-hospital care systems really I think can do, need to do more, there needs to be more support available to help patients get to and from CAR T centers, have the care that is needed to safely get CAR T as a patient, be able to manage the side effects that can come from having CAR T and have the support to deal with those side effects. Building more robust support structures for patients that extend beyond the walls of the hospital I think is really critical to improving equitable CAR T access for my own patients. I think it's important to remember that many patients who are eligible for CAR T are not receiving this therapy mostly because of barriers such as ability to come to one of our CAR T centers, you know CAR T really requires a very specialized center. Having more of these centers, which is slowly happening and covering more of the geography is helpful. Partnering with our community partners and physicians who can help us with supportive care, transitioning patients closer to home sooner will be definitely very helpful. Having the caregiver support and family and friends to stay with our patients for at least those first 60 days, we really have overcome a lot of the barriers and learned many lessons over our first few years and I think many more to come. CAR T cell therapy is a complicated treatment, right? It's a complex process, it's generally done in academic medical centers. It requires a patient to move from their home to a bigger city, generally speaking. You need a caregiver, you need transportation to be able to get there. So I think it's a difficult process overall and how can we kind of reduce the gap or make that access a little bit easier? I think there are multiple ways, obviously like providing financial support for patients or patient support programs is going to be super important, whether it be assistance with lodging or travel, I think those are going to be very important. Other considerations would be, for example, advocacy, right? Because these also can be very expensive treatment and we have to make sure that the insurance is covering these type of treatments and then there's no administrative overhead or problems. And then I think we have to be mindful of studies that look at these type of issues, for example, social determinants of health and different type of indices, depending on where somebody lives and having some kind of transparency and some kind of data in this type of social determinant of health studies, I think will be very important. But there's a lot of work that we need to do to help improve access and kind of close the gap so that most patients can receive the best treatment for them.