Patients with multiple myeloma may be vulnerable to financial toxicity, even those with health insurance and those who make more than $100,000 a year, due to the higher use of novel therapeutics and extended duration of myeloma treatment.

According to this study published in the Lancet Haematology (2015; doi:10.1016/S2352-3026(15)00151-9), nearly half of the 100 patients surveyed tapped into their savings to pay for their care, and 17% reported delays in treatment due to costs. Ten patients had stopped treatment altogether.

A relatively new term, financial toxicity is described as the burden of out-of-pocket costs experienced by patients that can affect their wellbeing and become an adverse event of treatment. Past studies suggest patients frequently employ coping mechanisms to help defray out-of-pocket costs, some of which compromise treatment adherence. It may also have a negative impact on quality of life; some reports suggest it may contribute to increased mortality.

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The study is from a team of researchers at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, including Edward Stadtmauer, MD, chief of Hematologic Malignancies and a professor of Hematology/Oncology, and Scott Huntington, MD, a faculty member at Yale University and formerly of the division of Hematology/Oncology at Penn. Huntington also presented preliminary data at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting.

“While advances in multiple myeloma therapy have contributed to significant improvements in patient outcomes, the clinical gains have come with rising costs,” Huntington said. “And today, because of these advances, most patients are on a new drug, compared [with] a decade ago when less than 5% were. So we’re not talking about a select group of patients faced with this burden—many are facing the financial challenges with treatment.”

Costs of newly approved blood cancer therapeutics have also increased 10-fold in the past 15 years, with many agents cost $10,000 or more per month.

For the study, the team used the COST (Comprehensive Score for Financial Toxicity) questionnaire among other survey questions. The COST tool measures various aspects of financial circumstances such as income, education, marital status, ability to work, and overall opinions about additional expenses, as well as the participants’ current financial situation.

Of the 100 patients from the Abramson Cancer Center who took part in the study, 59% labeled multiple myeloma treatment costs as higher than expected, and 70% indicated at least minor financial burden. A total of 36% reported applying for financial assistance, including 18% of patients who reported incomes of more than $100,000.

Use of savings was common (43%), 21% borrowed money to pay for medications, and 17% reported delays in treatments due to costs. More than half had to reduce their hours at work or quit since their diagnosis. Ten patients stopped treatment altogether due to the high costs.

Surprisingly, the study included patients with demographic characteristics likely to protect against financial burden. All participants were insured, and all patients with Medicare fee-for-service coverage had additional supplemental insurance to assist with out-of-pocket costs. They also had a median household income and education level higher than the national average.

The median age was 64 years and 53% were female. The median annual household income was reported between $60,000 and $79,999; 70% reported having some college education.

“While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients,” the authors wrote. “In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”