Breaking barriers: addressing disparities in CAR T-cell therapy access

Cancer breakthroughs don’t happen every day. But chimeric antigen receptor (CAR) T-cell therapy isn’t just another advancement – it’s a lifeline, particularly for patients with relapsed or treatment-resistant large B-cell lymphoma (LBCL), the most common form of non-Hodgkin lymphoma. This cutting-edge immunotherapy reprograms a patient’s own immune cells to target cancer cells, offering a powerful alternative when standard treatments fail and bringing renewed hope and the potential for long-term remission. The problem? Not all eligible patients may have equal access to CAR T-cell therapy and thousands of eligible patients never receive it.

In this Guest Column, Christie Teigland PhD (Vice President, Research Science and Advanced Analytics, Inovalon) and Karl M Kilgore PhD (Director, Research Science and Advanced Analytics, Inovalon) expose the systemic barriers that block access to CAR T-cell therapy and outline practical solutions to close the gap. Their published research, based on a large observational study using data from Inovalon’s MORE² Registry®, exposes striking disparities in treatment access and provides a roadmap for change.

This column is informed by peer-reviewed research highlighted in the white paper, Improving Access to CAR T-Cell Therapy for Patients With Lymphoma.

Who’s getting left behind?

On paper, CAR T-cell therapy should be available to all eligible patients with LBCL. Yet in reality the odds aren’t equal. Older adults, women, Black patients, lower-income individuals, and those who live far from treatment centers are far less likely to receive this breakthrough therapy.

The age penalty

The median age for patients with LBCL receiving CAR T-cell therapy is 70. For each year's increase in age, patients are around 4% less likely to receive CAR T-cell therapy.

“That gap isn’t just a number – it’s a missed opportunity to save lives. CAR T-cell therapy works for older adults, but outdated assumptions and referral biases may be keeping it out of reach.”

The gender divide

The gender gap is equally troubling. Men are 29% more likely to receive CAR T-cell therapy than women, even when other factors are accounted for. The reasons behind this discrepancy are unclear. Are providers less likely to suggest CAR T-cell therapy to women? Are women declining treatment at higher rates? More research is needed, but this disparity cannot be ignored.

The racial and economic gap

Race and income further define access. Black patients are less than half as likely as White patients to receive CAR T-cell therapy, even when controlling for income and geographic location. The implications are stark: barriers still exist that prevent patients of color from accessing the most advanced cancer treatments available.

Socioeconomic status plays a major role as well. Patients in the lowest income bracket are 50% less likely to receive CAR T-cell therapy than those in the highest bracket. Insurance type also matters – patients with commercial insurance are up to three-times more likely to receive treatment than those with Medicare or Medicaid. The high cost of CAR T-cell therapy, combined with indirect expenses like travel, lodging, and time off work, creates an insurmountable barrier for many.

The distance dilemma

Geography adds another layer of complexity. Patients who live 2–4 hours away from a treatment center are 36% less likely to receive CAR T-cell therapy. Those living more than 4 hours away didn’t see as steep a drop-off – suggesting that some patients may have alternative living arrangements near a treatment facility. For everyone else, the logistics of travel are simply too much to overcome.

Why are these disparities happening?

Bias, bureaucracy, and financial burdens all play a role in the treatment gaps. Providers may hesitate to refer older patients, despite strong evidence supporting the therapy’s effectiveness in this group. Gender-based disparities in oncology are well-documented, and CAR T-cell therapy appears to be no exception.

Barriers still exist that are contributing to racial disparities, where Black patients receive fewer referrals, and financial strain further compounds the issue. Even for insured patients, out-of-pocket costs, caregiver support, and travel expenses create significant obstacles.

Additionally, those with commercial insurance are 1.5- to 3-times more likely to receive treatment compared to Medicare or Medicaid patients, underscoring challenges in coverage approvals and reimbursement.

Closing the access gap

The first step in bridging the gap is acknowledging that these disparities exist. CAR T-cell therapy is a medical marvel, but it won’t reach its full potential if access remains limited.

Here are several ways to improve access:

• Educate providers and patients to reduce bias in referrals, especially for older adults and women
• Expand financial assistance programs to cover not just treatment, but travel and lodging
• Streamline insurance approvals to make access faster and fairer
• Increase awareness so more eligible patients know CAR T-cell therapy is an option
• Open more treatment centers in underserved areas to remove geographic barriers

The future of CAR-T cell therapy

CAR T-cell therapy is one of the most important breakthroughs in cancer treatment – but it won’t reach its full potential unless access improves. Demographic, clinical, and socioeconomic factors continue to influence who receives this life-saving treatment, creating barriers that prevent equitable care.

“By tackling these disparities head-on we can expand access to CAR T-cell therapy and ensure that this groundbreaking treatment reaches every patient who needs it, not just those who fit the mold.”

Download the full white paper for the data, insights, and strategies to close the access gap.

Authors

Christie Teigland, PhD
Vice President, Research Science and Advanced Analytics, Inovalon

Christie Teigland leads the design and implementation of studies focused on quality measurement, health equity, and health economics and outcomes research. She works closely with health plans, providers, and life science organizations to develop actionable, real-world data insights.

Teigland co-chaired the National Quality Forum (NQF) Scientific Methods Panel for four years and served on the Pharmacy Quality Alliance (PQA) Quality Measure Expert Panel and as co-chair of PQA’s Health Equity Technical Expert Panel, as well as on many Centers for Medicare & Medicaid Services (CMS) expert panels. She has served as principal investigator on large foundation and government-funded projects over two decades focused on improving healthcare quality.

Teigland earned her PhD in Economics and Econometric Forecasting from the University of New York at Albany.

Karl Kilgore, PhD
Director, Research Science and Advanced Analytics, Inovalon

Karl Kilgore has over 30 years of experience designing and developing health economics and outcomes studies, descriptive and analytic epidemiology studies, outcomes-based marketing programs, and disease registries.

Kilgore’s professional interests include social drivers of health, how social, behavioral and genetic factors interact to impact the health of individuals and populations, risk adjustment methodologies for health performance measurement and reimbursement, and real-world outcomes of novel therapies, particularly in oncology.

He received his PhD in Psychology from the University of Chicago with concentration in Epidemiology, Statistical Analysis, Research Methods, and Psychometrics.

Disclaimer

The opinions expressed in this feature are those of the author and do not necessarily reflect the views of The Evidence Base® or Becaris Publishing Ltd.

Sponsorship for this Guest Column was provided by Inovalon, Inc.