CAR T Delivery and Access: A Survey of Healthcare Providers

Introduction

Although studies evidence the relative safety and efficacy of chimeric antigen receptor T-cell therapy (CAR T), approximately 2 in 10 eligible patients receive CAR T. Healthcare providers (HCPs) must establish appropriate risk evaluation and mitigation strategies (REMS) to protect patient safety, while ensuring policies do not impede access. The aim of this study was to characterize the variation in CAR T authorized treatment centers’ (ATCs) policies regarding symptom monitoring, CAR T delivery, and caregiver requirements.   

Financial support for the Cancer Experience Registry (CER) was provided by Bristol Myers Squibb and Kite. 

Authors

Abigail Newell,PhD, Samantha Ammons, PhD, Belinda Paulicin, DSW, LCSW, OSW-C, Shannon Brown, MSW, LISW-CP, Erica E. Fortune, PhD, Caroline Offit, Elana Plotkin

1. Cancer Support Community, Washington, DC, USA
2. Oncology Education, Association of Cancer Care Centers, Chevy Chase, MD

Methods

We conducted a cross-sectional survey of U.S. HCPs (N=94) across 55 CAR T ATCs in November 2025 - April 2026. Eligible respondents were social workers (43%), nurse coordinators (19%), and other advanced practitioners in CAR T (see Table 1). Participants were recruited using convenience and purposive sampling to maximize variation in site type via Cancer Support Community’s Helpline and the Association of Cancer Care Centers networks. The survey assessed CAR T policies, implementation of REMS changes, and post-infusion care requirements. Descriptive statistics and chi-square tests were used to evaluate policy variation by ATC type (academic vs. community). 

Results

Most (86%) providers reported having formalized written caregiving policies at their ATC. 31% of HCPs reported that securing a caregiver sometimes prevented patients from getting CAR T. Community-based ATCs were more likely to offer outpatient CAR T infusions. Academic ATCs were more likely to offer a mix of inpatient and outpatient CAR T infusions. 

Conclusions

Securing a caregiver was a major barrier to CAR T access - with one third reporting it sometimes prevented eligible patients from receiving CAR T. Most HCPs at ATCs that made changes to CAR T policies following the FDA’s removal of REMS reported that the changes would make it easier for patients to access CAR T. HCPs at academic ATCs were more likely to identify limited patient understanding as a barrier to CAR T compared to those at community-based ATCs. Given the heterogeneity in policies, HCPs may benefit from peer education to streamline policies – particularly around caregiving - to reduce barriers to care.   

Keywords

 Access to care/healthcare utilization Caregiving Quality of care Social support and well-being CAR T