Towards a Frictionless CAR-T Therapy Process: Identifying and Prioritizing Procedural Preconditions for Oncologic Institutions Using Group Concept Mapping

OBJECTIVES: The complexity of the chimeric antigen receptor T-cell (CAR-T) therapy process leads to care inefficiencies and access barriers for oncologic patients. As the process consists of multiple activities performed by a range of stakeholders, the objective was to i) identify preconditions for a frictionless CAR-T process, ii) rate their importance and feasibility, and iii) prioritize them accordingly.

METHODS: A Group Concept Mapping (GCM) analysis was conducted surveying CAR-T experts from different professional backgrounds. By completing the following focus prompt, statements were brainstormed: “To ensure that the CAR-T cell therapy process - from initial indication to follow-up - runs as frictionless as possible, it takes ...?”. Participants sorted statements according to similarity resulting in a comprehensive cluster map reflecting the overarching topics. Participants rated the importance and feasibility of all statements. Mean ratings per cluster were calculated and discrepancies between rating dimensions were assessed. Ratings were compared between subgroups (above/below-average CAR-T cases per year).

RESULTS: In total, 20 participants (50% medical experts) contributed to the GCM analysis. 80 statements were collected, yielding 10 different clusters, with respective mean importance/feasibility ratings: Information for patients and physicians (4.16/3.77), Supportive network (4.03/3.53), Eligibility of patients (4.41/3.63), Evidence, transparency and communication (4.01/3.33), Paperwork (4.1/2.52), Interface with pharmaceutical manufacturer (4.03/2.85), Reimbursement (4.29/2.31), Quality Management (4.17/3.18), Infrastructure of CAR-T clinics (4.1/2.93), and Patient-oriented processes (4.46/3.32). Clusters Reimbursement and Patient-oriented processes showed notable discrepancies between high importance and low feasibility. As subgroup analysis showed, Reimbursement and Interface with pharmaceutical manufacturer are perceived less feasible by those treating an above-average number of cases annually.

CONCLUSIONS: The GCM analysis revealed relevant preconditions for a frictionless CAR-T process. Highly important topics should be prioritized. Highly/poorly feasible topics require less/more efforts to put them into practice. Anticipating partially increased barriers caused by higher case numbers will guide future implementation activities.