Access to Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma

Area of Science:

• Oncology
• Health Services Research
• Geographic Information Systems

Background:

• Geographic access to novel oncology therapies, including chimeric antigen receptor (CAR) T-cell therapy, is poorly understood.
• Patient travel burden may vary significantly based on the location and type of treatment centers.

Purpose of the Study:

• To examine how expanding CAR T-cell therapy administration sites impacts patient travel distances and time.
• To assess the relationship between travel time and patient sociodemographic factors.

Main Methods:

• Geographic Information System (GIS) techniques were used to calculate travel distances and times.
• Three scenarios of administration site expansion were evaluated: academic hospitals only, academic and community hospitals, and academic/community hospitals plus specialty oncology centers.
• Analysis included relationships between travel time and socioeconomic status, race, rural-urban location, and lymphoma clusters.

Main Results:

• Over 37% of eligible diffuse large B-cell lymphoma (DLBCL) patients traveled over 1 hour to the nearest academic hospital.
• Expanding sites to include community hospitals and specialty centers reduced average travel time by 23% and distance by 30%.
• Longer travel times were associated with lower socioeconomic status.

Conclusions:

• Many DLBCL patients face substantial travel burdens to receive CAR T-cell therapy at academic centers.
• Expanding CAR T-cell therapy administration sites through strategic site-of-care planning can improve geographic and sociodemographic equity.
• Addressing regional and rural-urban disparities is crucial for fair allocation of advanced cancer treatments.