Distance to nearest center

• Single-case agreement / out-of-networkHigh

  A distant, out-of-area site adds cross-plan paperwork that has to clear before scheduling can even begin

• Geographic access / distance to a centerHigh

  Over 150 miles or out-of-state turns care into a relocation, and uptake falls sharply as distance grows

• Travel & lodging burdenHigh

  Over 150 miles usually means weeks of lodging near the center — a large, front-loaded out-of-pocket cost

• Housing insecurity / relocation burdenHigh

  Over 150 miles means weeks living near the center — a housing arrangement that has to be secured up front

Home community

• Geographic access / distance to a centerHigh

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

• Travel & lodging burdenHigh

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

• Transportation barrierHigh

  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

Health-system navigation

• 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

• Equity / disparity riskWatch

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

• 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 hurdlesModerate

  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

anyDis

• Eligibility / patient-selection hurdlesModerate

  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

Household income

• Travel & lodging burdenHigh

  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 burdenHigh

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

Family understanding of CAR-T

• Health-literacy / navigation-complexity burdenModerate

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

• Awareness, understanding & hesitancyWatch

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

Center in home state?

• Single-case agreement / out-of-networkHigh

  Out-of-state treatment usually requires enrolling the provider in the patient's plan or Medicaid — a slow, extra step

• Geographic access / distance to a centerHigh

  No in-state center forces out-of-state care, adding travel plus cross-state coverage and enrollment steps

Center network status

• Single-case agreement / out-of-networkHigh

  Out-of-network care requires negotiating a single-case agreement before treatment — often several weeks of back-and-forth

• Insurance coverage & prior-authorizationWatch

  An out-of-network center means standard authorization doesn't apply — a special agreement has to be arranged first

Line of therapy

• Late referral / progression before treatmentHigh

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

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

Performance status

• Eligibility / patient-selection hurdlesModerate

  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 clearanceHigh

  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

Dedicated caregiver (~30 days)

• Caregiver & psychosocial clearanceHigh

  Centers require a 24/7 caregiver for ~30 days; without one, the center may not clear the patient to proceed at all

Transportation

• Transportation barrierHigh

  No reliable transport puts every appointment at risk, from work-up through the daily post-infusion monitoring window

Physical / mobility

• Transportation barrierHigh

  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

Housing

• Housing insecurity / relocation burdenHigh

  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