A Geographic Disparities Analysis Between Standard of Care and Clinical Trial CAR-T Patients in Kansas

This study compares demographics and geographic factors associated with access to chimeric antigen receptor (CAR)-T cell therapy for B-cell malignancies or multiple myeloma: individuals in clinical trials at the University of Kansas Cancer Center (KUCC) and those receiving standard-of-care (SOC) CAR-T at the University of Kansas Health System (TUKHS).

Data were collected from electronic medical records and the KUCC Clinical Trial Management System. We evaluated differences in CAR-T access across race, gender, age, rurality, and HPSA status. SOC patients received FDA-approved CAR-T between May 2021 and May 2023; clinical trial patients received investigational CAR-T between January 2015 and February 2023.

Most patients (80%) were from urban areas; 54.1% lived within 50 miles of the University of Kansas Medical Center (KUMC). The cohort was 58.4% male, 86.7% white, 60.4% aged 19-64, and 57% lived outside a Health Professional Shortage Area (HPSA). Rural patients made up 20% of both cohorts. No significant demographic differences were observed between clinical trial and SOC recipients. However, rural residence was significantly associated with age 65 or older (OR = 1.80), white race, HPSA status, and living more than 50 miles from KUMC (OR = 27.01). HPSA status was also associated with greater odds of living beyond the 50-mile radius (OR = 2.29).

Findings highlight important geographic disparities in CAR-T access. Targeted outreach to rural and HPSA-designated communities may improve equity and ensure broader access to advanced therapies.