Introduction

Geographic access to novel oncology therapies, and the extent to which it may vary by potential sites of care, regions, and population characteristics, is poorly understood. We examined how expanding access to chimeric antigen receptor (CAR) T cell therapy administration sites impacts patient travel distances and time.

Methods

We used geographic information system techniques to calculate shortest travel distance and time between patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) and the nearest CAR T cell therapy administration site in three scenarios: academic hospitals; academic and community multispecialty hospitals; and academic and community multispecialty hospitals plus nonacademic specialty oncology network centers. Main outcome measures were differences in travel distance and time among the scenarios and the relationship between travel time and socioeconomic status, race, rural–urban areas, and non-Hodgkin lymphoma clusters. Non-Hodgkin lymphoma incidence, socioeconomic status, and administration centers were derived from governmental/publicly available data sources.

Results

Of 3922 patients eligible for CAR T cell therapy, more than 37% had to travel more than 1 h to the nearest academic hospital. Average travel time and distance were significantly reduced by 23% and 30% (P < 0.001), respectively, when access was expanded to include community hospitals plus a broader range of oncology specialty treatment centers. Compared to academic hospitals alone, increasing access to include community hospitals decreased time and distance by 7% and 8% (P < 0.01), respectively. In addition, there would be a lower proportion of sites operating as the only care provider within 25 miles if access was expanded outside of academic hospitals only. Longer travel time was associated with lower socioeconomic status.

Conclusion

Many patients with DLBCL have long travel times to an academic hospital that administers CAR T cell therapy. Expanding access to care through site-of-care planning will help address regional, rural–urban, and sociodemographic equity in the geographic allocation of CAR T cell therapy.

中文翻译：

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获得嵌合抗原受体 T 细胞疗法治疗弥漫性大 B 细胞淋巴瘤

介绍

对新型肿瘤疗法的地理访问，以及它可能在多大程度上因潜在的护理地点、地区和人口特征而异，人们知之甚少。我们研究了扩大对嵌合抗原受体 (CAR) T 细胞治疗给药部位的访问如何影响患者的旅行距离和时间。

方法

我们使用地理信息系统技术计算了三种情况下复发/难治性弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者与最近的 CAR T 细胞治疗给药点之间的最短旅行距离和时间：学术医院；学术和社区多专科医院；以及学术和社区多专科医院以及非学术专科肿瘤网络中心。主要结局指标是不同情景之间旅行距离和时间的差异，以及旅行时间与社会经济地位、种族、城乡地区和非霍奇金淋巴瘤集群之间的关系。非霍奇金淋巴瘤发病率、社会经济地位和管理中心来自政府/公开数据来源。

结果

在符合 CAR T 细胞治疗条件的 3922 名患者中，超过 37% 的患者必须前往最近的学术医院超过 1 小时。 当访问范围扩大到包括社区医院和更广泛的肿瘤专科治疗中心时，平均旅行时间和距离分别显着减少了 23% 和 30% ( P < 0.001)。与仅学术医院相比，增加社区医院的可及性分别减少了 7% 和 8% 的时间和距离（P  < 0.01）。此外，如果仅将访问范围扩大到学术医院之外，那么作为 25 英里范围内唯一护理提供者的站点比例将会降低。较长的旅行时间与较低的社会经济地位有关。

结论

许多 DLBCL 患者前往进行 CAR T 细胞疗法的学术医院的旅行时间很长。通过护理地点规划扩大获得护理的机会将有助于解决 CAR T 细胞疗法地理分配中的区域、农村-城市和社会人口平等问题。