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

• Travel & lodging burdenHigh

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

• Housing insecurity / relocation burdenWatch

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

Home community

• Equity / disparity riskHigh

  Rural residence layers distance, workforce, and coverage gaps on top of other disadvantages

• Travel & lodging burdenHigh

  Rural patients travel farther at every step, compounding cost and time away from work and family

• Geographic access / distance to a centerModerate

  Rural homes sit far from the few certified centers, so the nearest option may be hours away

• Transportation barrierModerate

  Rural areas have little public transit, so the long drives fall entirely on the family

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 burdenWatch

  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

Distance to nearest center

• Travel & lodging burdenHigh

  76–150 miles means repeated paid travel and likely overnight stays around key visits

• Geographic access / distance to a centerModerate

  At 76–150 miles each visit is a half-day trip, which quietly suppresses referral, work-up completion, and follow-up

anyDis

• Eligibility / patient-selection hurdlesWatch

  Disability can be misread as ineligibility; without accommodations the assessment itself can exclude unfairly

• Disability-related access barrierModerate

  Exam tables, scanners, and clinic workflows often aren't accessible, so routine steps can be physically hard to complete

Line of therapy

• Late referral / progression before treatmentHigh

  Heavy pretreatment signals a late start and leaves little room before disease or organ function disqualifies

• Manufacturing / collection & vein-to-vein riskModerate

  Many prior lines wear down T-cells, lowering the odds of a successful manufacture on the first collection

Dedicated caregiver (~30 days)

• Caregiver & psychosocial clearanceModerate

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

Insurance

• Insurance coverage & prior-authorizationWatch

  Dual Medicare/Medicaid coverage splits responsibility between payers, and the handoff between them can stall authorization

Performance status

• Eligibility / patient-selection hurdlesWatch

  Borderline performance status invites extra scrutiny that can tip a selection decision the wrong way

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 clearanceModerate

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

Currently managed at

• Late referral / progression before treatmentHigh

  Community teams see CAR-T rarely, so an eligible patient is easy to overlook or refer only after more lines are used

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

Physical / mobility

• Transportation barrierModerate

  A mobility disability may require accessible transport, which is harder to arrange and schedule on short notice

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 barrierModerate

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

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