Though advances in the treatment of multiple myeloma (MM) have led to longer survival for MM patients, they have also resulted in increasingly complex therapeutic decisions and increased financial burden related to care – including medication co-pays and other out-of-pocket costs.
According to results from a survey-based study of financial distress in MM patients presented by Joanne S. Buzaglo, PhD, at the 2015 ASH Annual Meeting, this “financial toxicity” can affect both quality of life and treatment outcomes.
Dr. Buzaglo, senior vice president of research and training at the Cancer Support Community, and colleagues found that, as a patient’s monthly out-of-pocket costs increased, so did the amount of a given patient’s overall distress (p=0.009) and risk for depression (p=0.010). This linear relationship continued at least until those costs exceeded $1,000 a month, when the amount of distress and depression risk leveled off.
“The combination of high distress and financial burden places patients at risk for poorer adherence and health outcomes, as well as unremitting stress,” Dr. Buzaglo told ASH Clinical News. “All of these factors negatively impact quality of life.”
Of the 495 patients with MM who were enrolled in the “Cancer Experience Registry: Multiple Myeloma” (an online initiative to study and raise awareness about MM’s psychosocial impact), 266 patients completed surveys about the financial cost of MM and cancer-related distress and were included in this analysis. The study was conducted from July 2013 to 2014 and registrants were recruited through outreach efforts by the Cancer Support Community and the Leukemia & Lymphoma Society networks of communities and resources.
Median age among the 266 patients was 64 years, and most were female (52%) and white (92%). Median time since MM diagnosis was 4.5 years.
Annual income among patients was:
- <$40,000/year: 35%
- $40,000 to $79,000/year: 35%
- >$80,000/year: 30%
Nearly three-quarters of the patients (73%) reported spending at least $100 per month on out-of-pocket costs related to MM, while nearly half (48%) reported spending $250 or more and 22 percent spent $500 or more.
Concern about financial state was common: 47 percent of respondents reported being either moderately, seriously, or very seriously concerned about money or health insurance. In addition, 32 percent said they were experiencing intrusive ideation, or stress-related anxiety, related to costs of care.
Patients took a variety of steps to help cover the cost of care, but most reported making sacrifices in their medical care and in other areas of their lives to pay for their MM treatment:
- 35% cut their grocery expenses
- 35% used pharmaceutical assistance programs
- 32% had depleted their savings accounts during the course of their treatment
- 22% either borrowed against or used money from their retirement plans
- 17% delayed receiving psychological counseling or support
- 6% postponed filling prescriptions
- 5% admitted to skipping doses of medicine at times
“With the movement toward value-based cancer care, oncologists are encouraged to discuss costs with patients when considering treatment choice,” Dr. Buzaglo and co-authors noted, prompting them to look at patient-provider communication about cost. While most patients (56%) reported that a member of their health-care team had provided information about resources related to receiving financial support or financial counseling, just 28 percent said that their health-care team ever discussed how MM would affect their personal finances.
In the survey responses, MM patients would welcome financial planning assistance: 82 percent reported that financial counseling would be helpful “quite a bit” or “very much.” “Also, a large proportion of participants reported they would be “quite a bit” or “very much” willing to receive financial assistance for medications (81%) and cost of treatment (77%), and, to a lesser extent, for transportation costs (55%) and living expenses (46%),” Dr. Buzaglo and researchers reported.
“Patients who indicated that they had experienced financial burden when trying to pay for their cancer-related care were two-and-a-half times more likely to be at risk for depression than those who did not indicate financial burden,” said Dr. Buzaglo, who believes physicians have an opportunity to improve communication with their patients and help direct patients to financial resources and support.
Buzaglo J, Miller MF, Karten C, et al. Multiple myeloma patient experience with financial toxicity: findings from the Cancer Experience Registry. Abstract #874. Presented at the American Society of Hematology Annual Meeting, December 7, 2015; Orlando, FL.