Financial Toxicity Has ‘Notable Impact’ on Post-HSCT Quality of Life

Financial toxicity had a “notable impact” on patient quality of life for up to one year after hematopoietic stem cell transplant (HSCT), according to a recent study.

M. Qasim Hussaini, MD, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital and colleagues conducted the research and presented their findings during the 2023 American Society of Clinical Oncology Meeting.

They conducted the research because the “impact of pretransplant financial toxicity on quality-of-life outcomes following bone marrow transplant is unknown.” To address the question, they investigated the prevalence of financial toxicity in patients undergoing evaluation for HSCT and evaluated its impact on post-transplant clinical and health-related quality of life outcomes.

The cross-sectional study included patients who underwent an evaluation for allogeneic HSCT between January 2018 and September 2020 at a large academic medical center. During that time, 245 patients received evaluations for allogeneic HSCT.

The researchers measured financial health at baseline by using the Comprehensive Score for Financial Toxicity survey and measured quality of life at multiple time points with Functional Assessment of Cancer Therapy (FACT)-based questionnaires.

Nearly three-quarters (71.8%) of patients who were evaluated for transplant completed both questionnaires. Most patients (72.2%) were White and 63.1% were male. The median patient age was 57 years. The most common diagnoses were myelodysplastic syndromes in 39.2% of patients, leukemia in 38.1%, and lymphoma in 13.6%.

At the initial evaluation for HSCT, nearly half (47.2%) of patients reported no financial toxicity, while 29% reported mild financial toxicity, and 23.9% reported moderate to high financial toxicity.

“Compared to those with no financial toxicity, those with mild or moderate-high financial toxicity reported significantly reduced spending on leisure, food/clothing, used all or a portion of savings, borrowed money, or accumulated debt using a credit card, and did not fill a prescription due to costs (P<.0001 for all),” the study’s authors wrote.

Patients who had moderate to high financial toxicity at baseline had lower FACT scores at six months and at one year than those with mild or no financial toxicity at baseline (P=.0007, P=.0075, respectively).

However, two factors were associated with lower odds of financial toxicity. An age of older than 62 years (odds ratio, 0.4; 95% CI, 0.17-0.94; P=.03) and income equal or greater than $60,000 (odds ratio, 0.16; 95% CI, 0.07-0.36, P<.001) were both associated with lower odds of financial toxicity.

The researchers did not find associations between financial toxicity and selection for HSCT, overall survival, or nonrelapse mortality.

“Financial toxicity was highly correlated with patient-reported changes in behavior affecting their daily activities and transplant care, with notable impact on [quality of life] following transplant for up to one year,” the study’s authors concluded. “Early interventions by physician and social work-led teams may benefit patients who are at risk for financial toxicity.”

Reference

M. Qasim Hussaini, Ren Y, Lew M, et al. Financial toxicity and quality of life in patients undergoing bone marrow transplant evaluation: A single center analysis. Abstract #7052. Presented at the 2023 American Society of Clinical Oncology Annual Meeting; June 2-6, 2023; Chicago, Illinois.