Home community

• Geographic access / distance to a centerModerate

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

• Travel & lodging burdenModerate

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

• Transportation barrierWatch

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

• Equity / disparity riskWatch

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

Distance to nearest center

• 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

• Travel & lodging burdenModerate

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

Household income

• Travel & lodging burdenModerate

  On a limited income, uncovered travel and lodging can be the deciding factor in whether the patient actually shows up

• Financial toxicity / out-of-pocket burdenWatch

  Copays, ancillary drugs, and travel stack up quickly and, on a limited income, crowd out essentials

Family understanding of CAR-T

• Awareness, understanding & hesitancyWatch

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

• Health-literacy / navigation-complexity burdenWatch

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

Line of therapy

• Late referral / progression before treatmentHigh

  With 2+ lines already used, the window to refer while still eligible is closing

Age band

• Eligibility / patient-selection hurdlesHigh

  Some centers still use informal age cut-offs, so a fit 75+ patient can be screened out despite good real-world outcomes

Dedicated caregiver (~30 days)

• Caregiver & psychosocial clearanceWatch

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

Performance status

• Eligibility / patient-selection hurdlesHigh

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

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

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

Comorbidity burden

• Eligibility / patient-selection hurdlesHigh

  Significant comorbidities raise organ-function and safety concerns that weigh against selection