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A rapid assessment for financial toxicity was feasible in a busy clinical setting and allowed for effective and timely interventions. These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Thomas G. Knight, MD, coauthor of the study, was motivated by the fact that “financial toxicity is associated with treatment noncompliance, not only with medications, but extends to all aspects of medical care. This noncompliance has been been demonstrated to result in worsened outcomes. Patients with hematologic malignancies are thought to be extremely vulnerable to financial toxicity with rates of distress higher than other malignancies due to high cost of treatment and high healthcare utilization.”
Researchers from the Levine Cancer Institute in Charlotte, North Carolina, assessed all patients (N=107) with hematologic malignancy or bone marrow failure syndrome seeking treatment at the Malignant Hematology Clinic during a 6-month period. Patients were assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS-10) and 2 additional questions: “I know that I have enough money in savings, retirement, or assets to cover the cost of my treatment” and “I am satisfied with my current financial situation.” Patients were followed longitudinally for financial assistance outcomes over 12 months.
Demographics for study participants included median age, 58 years (range, 20 to 84); 56.1% were men; 63.6% were White; 40.2% were covered by Medicare; 72.9% were unemployed; and 32.7% earned less than $20,000 annually. The most common diagnoses were acute myeloid leukemia (32.71%), myelofibrosis (11.21%), and myelodysplastic syndrome (9.35%).
Patients were treated with intravenous chemotherapy (55.1%), oral chemotherapy (59.8%), immunotherapy (32.7%), and stem cell transplants (38.3%).
Those who required financial interventions had a high rate of noncompliance because they could not afford their prescribed medications (16.8%), over-the-counter medications (15.9%), or doctor visits (6.5%). Patients experiencing financial toxicity reported reducing their expenditures on food and clothing (48.6%) or leisure activities (56.1%), used their savings for medical costs (51.4%), and only partially filled their prescriptions (11.2%).
More than one-third of patients (37.4%) qualified for financial assistance and were helped with obtaining grants from external foundations. More than half (54.2%) of patients expressed interest in financial planning and were scheduled with a pro-bono financial counselor.
The awarded grants were valued at a median $850 (range, $100 to $17,850). Patients were able to receive free or reduced prescription medications at a median retail value of $197,158 (range, $29,909 to $639,801). Gas cards and food assistance with a median value of $300 (range, $100 to $300) were given to qualified patients.
Among those who received financial interventions, the PROMIS-10 physical (12.5±2.2 vs 13.7±1.8 points; P <.001) and mental (11.4±2.2 vs 12.4±2.2 points; P <.001) scores significantly improved.
The study authors concluded that assessing patients with malignancies for financial toxicity is both feasible in a busy healthcare setting and effective at connecting patients with much needed financial support.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Knight TG, Aguiar M, Robinson M, et al. Financial toxicity intervention improves quality of life in hematologic malignancy patients. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 430.