Logistical challenges of CAR T-cell therapy in non-Hodgkin lymphoma: a survey of healthcare professionals

Aim: Characterize the logistical challenges faced by healthcare professionals (HCPs), patients and caregivers during the chimeric antigen receptor T-cell (CAR T) treatment process for non-Hodgkin lymphoma patients.
Materials & methods: HCPs in the US and UK experienced with CAR T administration participated in interviews and completed a web-based survey.
Results: A total of 133 (80 US, 53 UK) HCPs participated. Two or more logistical challenges were identified by ≥60% of respondents across all stages of the CAR T process. Commonly reported challenges were lengthy waiting periods, administrative and payer-related barriers, limited healthcare capacity, caregiver support and (particularly in the US) patient out-of-pocket costs.
Conclusion: The CAR T treatment process presents numerous challenges, highlighting an unmet need for more convenient therapies.
Chimeric antigen receptor T-cell (CAR T) therapy is a new treatment for patients with non-Hodgkin lymphoma that have not responded to other types of treatment. CAR T therapy uses a person's own immune cells (T cells), which are modified in a laboratory to attack cancer cells. While CAR T therapy has the potential to be effective, there are challenges associated with the treatment process. In this study, we surveyed 133 healthcare professionals (HCPs) in the United States and United Kingdom to understand their experiences with logistical challenges involved in navigating the CAR T process. More than 60% of participants identified two or more logistical challenges at every stage of the CAR T treatment process. The most commonly reported challenges included long waiting periods, limited room at hospitals, availability of caregivers to support patients and issues related to out-of-pocket costs, travel and lodging for patients who are treated at specialized centers. In the United States, challenges related to insurance coverage and out-of-pocket costs for patients were highlighted. More than half of HCPs reported that patients' cancer getting worse while waiting to receive CAR T was a reason why patients may not proceed to treatment. While operational improvements might address some challenges in the CAR T treatment process, these findings highlight the need for more convenient, readily available and easily administered therapies for patients with non-Hodgkin lymphoma.
While chimeric antigen receptor T-cell (CAR T) therapy represents an advancement in the treatment of non-Hodgkin lymphoma, it is associated with a number of logistical challenges for patients, caregivers and healthcare professionals (HCPs).
We surveyed physicians, nurses and other HCPs involved in the various stages of CAR T therapy administration in the US and UK to characterize logistical challenges at each stage of the CAR T process.
Initial in-depth qualitative interviews (n = 25) of HCPs highlighted lack of caregiver support, time and administration, travel and accommodations and payer access as key themes.
In a subsequent quantitative survey of HCPs (n = 133), more than 60% of respondents identified at least two logistical challenges faced at every stage of CAR T administration.
Respondents most commonly reported challenges related to lengthy waiting periods, slow approval processes, limited capacity and availability of caregiver support.
More than half of respondents reported rapid disease progression as a common reason why eligible patients do not proceed to CAR T infusion.
The availability of caregiver support was selected as a logistical challenge present at every stage of the CAR T treatment process.
Respondents highlighted out-of-pocket costs, travel and lodging challenges throughout the CAR T process, although out-of-pocket costs and insurance-related challenges were more pronounced in the US than in the UK.
This study adds to the growing body of literature addressing the logistical challenges associated with CAR T therapy.
A PDF version of this infographic is available as supplemental material.