Financial Toxicity and Quality of Life in Patients Undergoing Stem-Cell Transplant Evaluation: A Single-Center Analysis.

in JCO oncology practice by S M Qasim Hussaini, Yi Ren, Alessandro Racioppi, Meagan V Lew, Lauren Bohannon, Ernaya Johnson, Yan Li, Jillian C Thompson, Bethany Henshall, Maurisa Darby, Taewoong Choi, Richard D Lopez, Stefanie Sarantopoulos, Cristina Gasparetto, Gwynn D Long, Mitchell E Horwitz, Nelson J Chao, S Yousuf Zafar, Anthony D Sung

TLDR

  • The study looked at how much money people had to spend on things like food and clothes before they got a transplant. They found that some people had to cut back on spending because they didn't have enough money. This made them feel worse about their quality of life after the transplant. The study also found that older people and people who made more money were less likely to have this problem. The study highlights the importance of finding ways to help people with financial toxicity feel better after a transplant.

Abstract

We investigated the prevalence of financial toxicity in a population undergoing hematopoietic cell transplantation (HCT) evaluation and measured its impact on post-transplant clinical and health-related quality-of-life outcomes. This was a prospective study in patients undergoing evaluation for allogeneic HCT between January 1, 2018, and September 23, 2020, at a large academic medical center. Financial health was measured via a baseline survey and the comprehensive score for financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) survey. The cohort was divided into three groups: none (grade 0), mild (grade 1), and moderate-high financial toxicity (grades 2-3). Health-related quality of life outcomes were measured at multiple time points. Multivariate logistic regression analysis evaluated factors associated with financial toxicity. Kaplan-Meier curves and log-rank tests was used to evaluate overall survival (OS) and nonrelapse survival. Of 245 patients evaluated for transplant, 176 (71.8%) completed both questionnaires (median age was 57 years, 63.1% were male, 72.2% were White, and 39.2% had myelodysplastic syndrome, 38.1% leukemia, and 13.6% lymphoma). At initial evaluation, 83 (47.2%) patients reported no financial toxicity, 51 (29.0%) with mild, and 42 (23.9%) with moderate-high financial toxicity. Patients with financial toxicity reported significant cost-cutting behaviors, including reduced spending on food or clothing, using their savings, or not filling a prescription because of costs (< .0001). Quality of life was lower in patients with moderate-high financial toxicity at 6 months (= .0007) and 1 year (= .0075) after transplant. Older age (>62; odds ratio [OR], 0.33 [95% CI, 0.13 to 0.79];= .04) and income ≥$60,000 in US dollars (USD) (OR, 0.17 [95% CI, 0.08 to 0.38];< .0001) were associated with lower odds of financial toxicity. No association was noted between financial toxicity and selection for transplant, OS, or nonrelapse mortality. Financial toxicity was highly correlated with patient-reported changes in compensatory behavior, with notable impact on patient quality of life after transplant.

Overview

  • The study investigates the prevalence of financial toxicity in patients undergoing hematopoietic cell transplantation (HCT) evaluation and its impact on post-transplant clinical and health-related quality-of-life outcomes. The study uses a prospective design with a cohort of 245 patients evaluated for transplant between January 1, 2018, and September 23, 2020, at a large academic medical center. Financial health was measured via a baseline survey and the comprehensive score for financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) survey. The cohort was divided into three groups: none (grade 0), mild (grade 1), and moderate-high financial toxicity (grades 2-3). Health-related quality of life outcomes were measured at multiple time points. Multivariate logistic regression analysis evaluated factors associated with financial toxicity. Kaplan-Meier curves and log-rank tests were used to evaluate overall survival (OS) and nonrelapse survival.

Comparative Analysis & Findings

  • Patients with financial toxicity reported significant cost-cutting behaviors, including reduced spending on food or clothing, using their savings, or not filling a prescription because of costs (< .0001). Quality of life was lower in patients with moderate-high financial toxicity at 6 months (= .0007) and 1 year (= .0075) after transplant. Older age (>62; odds ratio [OR], 0.33 [95% CI, 0.13 to 0.79];= .04) and income ≥$60,000 in US dollars (USD) (OR, 0.17 [95% CI, 0.08 to 0.38];< .0001) were associated with lower odds of financial toxicity. No association was noted between financial toxicity and selection for transplant, OS, or nonrelapse mortality. Financial toxicity was highly correlated with patient-reported changes in compensatory behavior, with notable impact on patient quality of life after transplant.

Implications and Future Directions

  • The study highlights the prevalence of financial toxicity in patients undergoing HCT evaluation and its impact on post-transplant clinical and health-related quality-of-life outcomes. The findings suggest that financial toxicity is associated with cost-cutting behaviors and lower quality of life after transplant. The study identifies older age and income as factors associated with lower odds of financial toxicity. Future research could explore the impact of financial toxicity on long-term outcomes and the effectiveness of interventions to mitigate financial toxicity in patients undergoing HCT.
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