Abstract
Background:
Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment of relapsed or refractory hematologic malignancies, yet access remains limited by geographic, logistical, and socioeconomic barriers. Patients residing over 90 miles from treatment centers, often in rural or underserved areas, face treatment delays and worse outcomes, including higher infection-related mortality and lower survival. However, some studies suggest that timely delivery is possible through coordinated regional networks. To address access disparities, Augusta University's Georgia Cancer Center (GCC) established satellite programs across Georgia and South Carolina. The impact of this model in preserving quality of care and timeliness across diverse populations, however, remains to be fully evaluated.
This study aims to evaluate the impact of GCC's satellite clinical programs located in Columbia, South Carolina; Athens, Georgia; and Savannah, Georgia in providing access for CAR-T cell therapy patients. Specifically, we address whether these programs are effective in expanding outreach while maintaining the same quality and timeliness of care. By analyzing referral patterns, distance to treatment centers, and decision-to-vein times, we aim to determine the impact our new programs have made to patients across the Georgia and South Carolina rural and underserved communities.
Methods:
We conducted an observational, retrospective chart review of patients who underwent CAR-T cell infusion therapy at the GCC between 2021 and 2025. Data collected included patient demographics, disease type, referral status (internal vs. external), and time from initial CAR-T cell discussion to infusion (decision-to-vein time). Geographic data was used to calculate driving distance and estimated travel time to the GCC using patient addresses. Median household income estimates were determined from the U.S. Census Bureau data at the block group level and mapped using QGIS.
Results:
A total of 63 patients were included: Non-Hodgkin's Lymphoma (NHL), n=42; Acute Lymphoblastic Leukemia (ALL), n=12; Multiple Myeloma (MYE), n=9). The median age at infusion was 63 years. The cohort was 69.8% White, 23.8% Black, and 6.4% Other; 54% were male and 46% female. Referral patterns indicated that 9 patients (14%) were referred internally (from within Wellstar MCG), while the remaining 54 patients (86%) were referred from external institutions. Externally referred patients traveled farther than internal referrals, with a median estimated travel time of 1.99 (range: 0.05-5.85) hours versus 0.30 (range: 0.21-3.48) hours, respectively. The median decision-to-vein for externally and internally referred patients was 3 (range: 0-11) months and 1 (range: 0-3) month, respectively. Median estimated household income for externally and internally referred patients was $58,606 (range: $10,332-$263,232) and $74,659 (range: $51,164-$100,368), respectively, based on patient notes and residential census tract data.
Conclusion: Augusta University's Georgia Cancer Center satellite clinical programs appear effective in expanding access to CAR-T cell therapy across Georgia and South Carolina. In our cohort most patients were externally referred, with some traveling over five hours for treatment which is considerably more compared to other academic institutions. Further, externally referred patients have lower incomes compared to our internally referred patients, allowing us to provide needed care to underserved populations.
Although the decision-to-vein time is shorter for internal referrals, averaging around one month compared to three months for external referrals, care remained timely and uncompromised despite travel burdens and social and financial constraints. This reflects how sustained collaboration with community oncologists in a decentralized cancer care model can provide equitable access to advanced cellular therapies.
