Equity in Neurotoxicity Care in the Era of Cancer Immunotherapy

Immunotherapies such as chimeric antigen receptor T cell (CAR-T) therapy and immune checkpoint inhibitors have improved cancer survival but are associated with potentially severe neurotoxicities that can impair neurologic function, quality of life, and survival. Despite their growing use, substantial disparities persist in the recognition, diagnosis, and management of cancer therapy-related neurotoxicities, disproportionately affecting underserved populations. In this review, we apply the social-ecological model (SEM) to examine how factors across individual, interpersonal, organizational, community, and policy levels contribute to inequities in neurotoxicology care. We synthesize evidence on barriers to early detection and access to neurologic expertise and highlight emerging strategies to promote equity, including early symptom recognition, improved specialty access, and supportive institutional infrastructure. We also explore the potential of behavioral economics-informed approaches and artificial intelligence-enabled tools, including telemedicine and remote monitoring, as scalable strategies to reduce inequities in neurotoxicity care.