On Location 2015 ASH Annual Meeting
Multiple Myeloma Patients Experience
Heavy Financial Burden, High Financial
Toxicity
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 outof-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.
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ASH Clinical News
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. ●
Patients with AML
Experience Significant
Symptom Burden,
Declining Quality of Life
Following Induction
Therapy
Remission induction therapy for patients with acute
myeloid leukemia (AML) is intensive, necessitating a
four-to-six-week hospitalization. In a study examining
whether the treatment also translated into more intensive
symptom burden, investigators discovered that patients
with AML face significant symptom burden and a decline
in quality of life throughout treatment induction, which
suggests a need to initiate palliative care services.
“Patients receiving induction chemotherapy for AML
have a more significant symptom burden than we often
realize despite our best efforts at aggressively managing
their symptoms,” said the study’s lead author, Thomas
W. LeBlanc, MD, MA, from Duke Cancer Institute and
the Division of Hematologic Malignancies and Cellular
Therapy at Duke University School of Medicine. The
research was presented at the 2015 ASH Annual Meeting.
The study enrolled 43 inpatients with AML undergoing intensive induction chemotherapy. Patients had
a mean age of 59.4 years, and 49 percent (n=21) were
female. The researchers evaluated patients on a weekly
basis to assess their symptoms, quality of life, and distress
during a month-long hospitalization for induction. Patients were then evaluated monthly in follow-up using the
following three tools:
• Patient Care Monitor v2.0 (PCM)
• Functional Assessment of Cancer Therapy–
Leukemia (FACT-Leu)
• National Comprehensive Cancer Network (NCCN)
distress thermometer (DT)
REFERENCE
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.
February 2016