Household income

• Financial toxicity / out-of-pocket burdenHigh

  Below poverty, even modest out-of-pocket costs force impossible trade-offs that can derail treatment

• Equity / disparity riskHigh

  Low income stacks travel, lodging, time-off, and coverage hurdles that each thin the odds of finishing care

• Housing insecurity / relocation burdenModerate

  On a low income, paying for weeks of lodging away from home is usually out of reach without help

• Travel & lodging burdenWatch

  Below poverty, front-loaded travel and lodging costs are often simply unaffordable without assistance lined up first

Health-system navigation

• Equity / disparity riskHigh

  Harder to grasp eligibility, ask the right questions, and self-advocate — so these patients are identified and referred less often

• Health-literacy / navigation-complexity burdenModerate

  The pathway spans dozens of visits, forms, and authorizations; without hands-on navigation, steps get missed and patients fall behind

• Language & communication barrierWatch

  Dense medical explanations may not land, so key instructions and warning signs can be missed unless teach-back is used

Disease pace

• Late referral / progression before treatmentHigh

  Fast-moving disease can outrun the refer-and-work-up timeline, so any delay risks losing the treatment window

• Eligibility / patient-selection hurdlesWatch

  Rapid progression can erode fitness mid-work-up, so someone eligible today may not be by the time they are assessed

• Manufacturing / collection & vein-to-vein riskModerate

  The 2–8 week manufacturing wait is hard to survive when disease is moving fast, which makes strong bridging therapy critical

Expresses hesitancy, fear of toxicity, or mistrust

• Awareness, understanding & hesitancyHigh

  Fear of toxicity or mistrust can lead to hesitation or outright refusal even when the patient is a strong candidate

• Health-literacy / navigation-complexity burdenModerate

  Mistrust can cause hesitation, missed visits, or declined steps that stall the whole process

Family understanding of CAR-T

• Awareness, understanding & hesitancyHigh

  New to CAR-T, the family may over- or under-estimate risk and benefit, which makes decisions harder and slower

• Health-literacy / navigation-complexity burdenModerate

  Brand-new to cell therapy, the family has a lot to absorb quickly just to keep decisions on schedule

Insurance

• Insurance coverage & prior-authorizationModerate

  With no plan in place there is no payer to authorize — coverage has to be secured before anything else can proceed

• Financial toxicity / out-of-pocket burdenHigh

  Uninsured, the six-figure therapy plus surrounding care is unaffordable without emergency coverage or assistance

Dedicated caregiver (~30 days)

• Caregiver & psychosocial clearanceHigh

  An unconfirmed caregiver can hold up psychosocial clearance until a concrete, named plan is in place

Caregiver & work

• Caregiver & psychosocial clearanceHigh

  If the caregiver can't take ~a month of leave without losing income, the required round-the-clock coverage can fall through

Financial cushion

• Financial toxicity / out-of-pocket burdenHigh

  With little savings, one unexpected bill or lost paycheck can halt participation mid-course

Living situation

• Caregiver & psychosocial clearanceHigh

  Living alone means no built-in caregiver, so one has to be recruited to meet the requirement

minority

• Equity / disparity riskHigh

  Documented referral bias and trial under-representation mean minority patients reach CAR-T less often at each step of the path

Currently managed at

• Late referral / progression before treatmentHigh

  No referral is moving yet — the clock toward a CAR-T center hasn't started

Referring team & CAR-T

• Late referral / progression before treatmentHigh

  A team unfamiliar with CAR-T may not spot candidacy or know when and where to send the patient

Transportation

• Transportation barrierWatch

  Depending on others or transit makes frequent, time-sensitive visits fragile — a missed ride becomes a missed step

Housing

• Housing insecurity / relocation burdenModerate

  The protocol needs a stable home base near the center; unstable housing can make that stretch impossible to arrange

Income during treatment

• Financial toxicity / out-of-pocket burdenHigh

  Weeks away from work with no paid leave cut household income at exactly the moment costs are spiking