Caregiver Gaps Limit Access to New Therapies: Thomas LeBlanc, MD, MA

Caregiver availability is emerging as a major obstacle to accessing transplant, chimeric antigen receptor (CAR) T-cell therapy, and bispecific antibody treatment, according to Thomas LeBlanc, MD, MA, chief patient experience and safety officer at Duke Cancer Institute. He spoke in Nashville, Tennessee, at the 2026 Patient-Centered Oncology Care® conference during the panel "No Caregiver, No Cure: Supporting Those Who Ensure Cancer Treatments Reach Patients in Need."

Caregiver Requirements Persist in Cell Therapy

"The adage historically has been ‘no caregiver, no transplant,’" LeBlanc said in an interview with The American Journal of Managed Care^®. Although the rule is less rigid today, patients receiving a stem cell transplant still need someone with them 24/7 during the high-risk phases, typically the first 60 to 100 days.

Newer targeted immunotherapies add complexity. Some patients travel to tertiary care centers, such as Duke, solely to receive bispecific therapy, which cannot always be given near their homes because of the risk of neurotoxicity, cytokine release syndrome, and related complications. These patients need a caregiver present for step-up dosing, particularly during the first several weeks of treatment.

"It really has become a barrier for a lot of people to getting these novel therapies," LeBlanc said.

Health Systems Lack Caregiver Replacement Infrastructure

LeBlanc said most systems rely almost exclusively on the presence of a caregiver. Patients without a spouse, an adult child, or another close person living nearby may therefore be unable to receive the newest and potentially most effective treatments.

Resources to supplement missing caregiver support are limited, he noted. LeBlanc said he is not aware of any health system with a robust caregiver replacement infrastructure, and such support is generally not covered by insurance or provided by health plans.

"And yet you can't get these therapies without having that kind of support," he said.