Financial Toxicity in a Phase I/II Trial of LV20.19 CAR-T Cell for B-cell Malignancies: A Longitudinal, Qualitative Study.

Financial toxicity, the economic burden associated with cancer treatment, is an evolving concern for patients undergoing innovative therapies like chimeric antigen receptor T-cell (CAR T-cell) therapy. The high costs of CAR T-cell therapy pose significant financial challenges, impacting well-being and treatment adherence. This study explores the financial burdens experienced by patients and caregivers across the CAR T-cell treatment course. Seventeen patients receiving CAR T-cell therapy were interviewed at four time points: preinfusion (baseline), D 90, D 180, and 1-yr post-treatment. Semi-structured interviews explored financial experiences, including direct medical costs, insurance coverage, caregiving demands, and ancillary expenses. Interviews were analyzed using thematic analysis to identify key patterns and track how financial concerns changed over time. Six themes emerged: (1) financial strain on caregivers, (2) employment disruptions, (3) healthcare and insurance costs, (4) relocation and travel expenses, (5) long-term financial planning, and (6) financial assistance navigation. Initially, patients were most concerned about treatment access and insurance approval. By D 90, stress shifted to out-of-pocket costs and job-related disruptions. At later time points, patients emphasized sustained financial planning and recovery-related expenses. Patients receiving CAR T-cell therapy face significant and evolving financial burdens. Key stressors include caregiving-related financial strain, insurance complexities, and travel-related expenses. Interventions such as caregiver support, upfront financial counseling, and clearer insurance communication may reduce this burden. Future research should evaluate interventions aimed at alleviating these financial stressors and promoting equitable access to CAR T-cell therapy.