A Crisis of Access to CAR T-Cell Therapy: One Oncologist’s Call to Action
- While CAR T-Cell Therapy has changed the standard of care for patients with relapsed or refractory large B-cell lymphoma (LBCL) in recent years, new data suggests there are large swaths of patients eligible for the treatment who do not have access to it.
- A specialist from the University of Kansas Cancer Center, Dr. Joseph McGuirk, is among a number of oncologists referring to the access gap as a “national crisis” that might account for the unnecessary loss of tens of thousands of lives.
- Gaps in Access to CAR T are most often attributed to geography, lack of efficient referrals between major cancer centers and community/ rural clinicians, lack of public awareness about the efficacy of CAR T, and assumptions about who may or may not be eligible.
- Dr. McGuirk outlines important potential solutions to closing this gap in access, including better communication between cancer center doctors and their community and rural counterparts, the creation of satellite treatment centers in largely rural areas, better public awareness, more efficient manufacturing and delivery, and a greater emphasis on making the treatment available across racial, socio-economic, and age barriers.
CAR T-cell therapy has fundamentally changed the outlook for patients with relapsed or refractory large B-cell lymphoma (LBCL), delivering response rates and durability that far exceed historical standards. Now supported by randomized trials and FDA approvals in both the second- and third-line settings, CAR T therapy is intended to be used with curative intent. Yet in real-world practice, most patients who are eligible for this life-saving treatment never receive it, and now, one leading specialist in the treatment of blood cancers is sounding the alarm bell about what he calls a “national crisis”.
“The overwhelming majority of patients for whom CAR T should be considered a standard-of-care and potentially curative therapy never receive it,” said Dr. Joseph McGuirk, professor of medicine and division director of hematologic malignancies and cellular therapeutics at the University of Kansas Cancer Center. “That is a national shame, and it’s tragic.”
Measuring the Access Gap
Dr. McGuirk recently presented data at the American Society of Hematology meeting examining CAR T utilization using real-world, patient-level data. The study followed more than 10,000 patients with recurrent or refractory LBCL, comparing outcomes before and after CAR T became commercially available.
The findings from research done by Dr. McGuirk and a group of other specialists appeared in an abstract in the Hematology Journal Blood delivered at 67th annual ASH Meeting in November, 2025 titled Real-world treatment patterns and survival outcomes in second and third line settings in large B-cell lymphoma (LBCL)
Using the Flatiron Health Research Database, investigators identified patients who met eligibility criteria under current treatment guidelines. Despite FDA approval and widespread recognition of CAR T’s efficacy, uptake remained strikingly low. Only 35% of eligible third-line patients received CAR T therapy. In the second-line setting—where CAR T is now a guideline-supported standard of care—just 25% of eligible patients were treated with CAR T.
“This is patient-level data, not estimates,” Dr. McGuirk said. “It clearly shows that even when CAR T is available and approved, the majority of patients who should receive it do not.”
Why Patients Aren’t Getting CAR T
According to Dr. McGuirk, the reasons behind the CAR T access gap are complex but well-defined.
Geography remains a major barrier. CAR T therapy is delivered at specialized centers, often located far from rural and underserved communities. Prior research from Dr. McGuirk’s group demonstrated a near-linear relationship between distance from a CAR T center and likelihood of receiving therapy.
“The further away patients live—particularly in rural areas—the less likely they are to receive CAR T,” he said.
Socioeconomic and demographic disparities further limit access, with lower utilization documented among racial and ethnic minority patients. Manufacturing timelines also remain a challenge for aggressive diseases like LBCL, where rapid progression can render patients ineligible while awaiting cell production.
Finally, delayed or missed referrals—often driven by lack of familiarity with indications, urgency, or outcomes—can close the window for treatment before patients ever reach a CAR T center.
What Can Be Done
Dr. McGuirk believes closing the access gap requires earlier referrals, broader education, and a clearer understanding of who can benefit from CAR T therapy.
Improving referral patterns—particularly from community and rural oncology practices—is critical. Many patients are managed outside academic centers, and delays in recognizing when CAR T should be considered can be decisive.
“Any delay in accessing CAR T therapy is a threat to the patient’s wellbeing,” Dr. McGuirk said. “Hours and days matter.”
He emphasized that accredited CAR T centers are designed to move quickly once patients are referred, often evaluating patients within 24 hours and collecting cells within days. That speed, however, depends on early recognition and timely referral.
In an initiative led by the team at the University of Kansas Cancer Center, Dr. McGuirk says establishing networks of satellite treatment centers in rural areas 400 miles or more from major cancer centers will provide for greater access and help patients get therapy without being far from home or work for an extended period of time.
Dr. McGuirk also points to a significant public awareness gap. Many patients and caregivers are unaware that CAR T exists or that it may offer curative potential for certain blood cancers. Without that knowledge, patients may never ask about the therapy—or seek a second opinion—until it is too late.
Age-related bias is another persistent obstacle. Older patients are frequently excluded based on chronological age rather than physiologic fitness, despite mounting evidence that CAR T can be safely administered in selected older adults.
“Age alone is arbitrary,” Dr. McGuirk said. “Fit older patients should not be denied potentially curative therapy simply because of their age.” Dr. McGuirk said he has patients in their 80’s and 90’s currently benefiting from CAR T-Cell therapy and managing associated toxicities.
Above all, he stresses that CAR T therapy must be understood for what it is: not a last-ditch option, but a treatment delivered with the intent to cure.
