Cellular therapies such as chimeric antigen receptor (CAR) T-cell therapy and tumor-infiltrating lymphocytes (TILs) are rapidly changing the treatment landscape for patients with relapsed or refractory malignancies. According to Folashade Otegbeye, MBChB, MPH, associate professor and the Fleischauer Family Endowed Chair in Cell and Gene Therapy Translation at Fred Hutchinson Cancer Center and the University of Washington, “We’re seeing remarkable responses—some lasting years—even in heavily pretreated patients.”
CAR T-cell therapies involve collecting a patient’s T cells from their blood, genetically modifying them to target cancer-specific antigens with amplified killing ability and reinfusing them to attack the tumor. TILs, by contrast, are harvested directly from the tumor and expanded outside the body without genetic alteration, then returned to the patient to enhance immune response by providing large numbers of tumor-sensitized cells. Both treatments have shown remarkable results, particularly in hematologic cancers and melanoma.
But despite their promise, these therapies remain out of reach for many patients.
Where the Barriers Begin
The process of delivering cell therapy is long and resource-intensive. It starts with referral to a specialized treatment center, followed by evaluation, cell harvesting, several weeks of manufacturing, chemotherapy, and infusion. Each step introduces logistical and financial hurdles, not just for patients, but for the entire care team.
“Navigating this journey takes more than clinical approval,” said Dr Otegbeye at the 2025 Summit on Cancer Health Disparities in Seattle, WA. “Patients need lodging close to and travel to the treatment center, continuously available caregivers, education, and ongoing support, often for weeks or months.”
In some cases, patients may receive bridging chemotherapy while their personalized treatment is being manufactured. If complications occur, they may no longer be eligible to receive the product. Even after infusion, risks such as cytokine release syndrome and neurologic toxicity require close monitoring, often as an inpatient or through intensive outpatient care for several weeks.
These touchpoints demand careful coordination, frequent follow-up, and consistent communication among providers, nurses, and navigators.
When Safety Protocols Limit Access
To minimize risk, CAR T-cell therapies require strict monitoring during the high-risk period after infusion. “For commercially approved products, patients are required to stay within 2 hours of the treatment center and have a caregiver available for at least 30 days,” Dr Otegbeye explained. Based on geographic location, surrounding infrastructure, patient and product complexity, various treatment centers have even tighter distance requirements for local lodging. While these decisions are made with the patient’s safety in mind, they also exclude many patients who simply cannot meet those demands.
At Fred Hutch, housing near the treatment center in Seattle, WA, is expensive, and Medicaid only reimburses up to $90 per night, while local rates often exceed $100. This puts low-income patients at a disadvantage.
Caregiver availability adds another layer of complexity. “If someone’s working, caring for children, or can’t afford to relocate to local lodging with the patient for the month of treatment, it can make the patient ineligible,” said Dr Otegbeye. “We call it the caregiver conundrum.”
These policy-level challenges often fall to nurses, social workers, and navigators to solve in real time, and even when resolved results in delays to treatment.
The Power of Referral and Education
Only approximately 4% of US cancer centers currently offer CAR T-cell therapies, meaning the majority of patients rely on community oncologists to identify them as candidates and make a referral.
“There’s an education gap, not just for patients but for providers too,” Dr Otegbeye said. “We have to ensure that referring physicians, especially those in rural or under-resourced areas, are aware of the options and how to navigate the referral process.”
At Fred Hutch, the new IMTX Access Initiative is analyzing referral patterns from 2016 to 2024. “We’re looking at where our referrals come from, where they drop off, and which areas we’re not reaching,” she explained. “It’s helping us ask better questions: who are we missing, and why?”
Nurses and navigators, especially those embedded in community programs, can help bridge this gap by promoting education, building trust, and facilitating access early in the patient journey.
Inequity That Can’t Be Ignored
Systemic and racial inequities compound the challenge. “Multiple studies show that patients from racial and ethnic minority groups have lower access to cellular therapies,” Dr Otegbeye noted. “It’s not about biology; it’s about access.”
Patients who live farther from treatment centers are also less likely to receive therapy, regardless of disease severity. Even within King County, where Fred Hutch is based, patients just outside a 30-minute treatment radius face significant hurdles.
“Sometimes we see patients from much farther away, but not from nearby counties,” she said. “That tells us it’s not just geography; it’s about resources, housing, transportation, and support systems.”
Moving Toward Solutions
While Fred Hutch has launched the IMTX Access Initiative to identify and resolve internal access gaps, on a national level, the ACCESS Initiative, led by the American Society for Transplantation and Cellular Therapy and the National Marrow Donor Program, is promoting policy reform and best practices across the field.
But Dr Otegbeye emphasized that real progress depends on continued collaboration: “We have to work together to make sure we’re not leaving anyone behind.”
Source
- Otegbeye F. Access to cellular therapy. Breakout Session Opening Talk. Presented at: 2025 Summit on Cancer Health Disparities. April 25-27, 2025; Seattle, WA.