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Acute leukemia patients ‘particularly vulnerable’ to financial toxicity of care
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SAN DIEGO — In a recent survey, about half of patients with acute myeloid leukemia or acute lymphoblastic leukemia reported being affected by financial toxicity of care, which was associated with lower mental and physical scores and a nonsignificant trend in decreased survival, according to data presented at the ASH Annual Meeting and Exposition.
Greg Knight, MD, physician in the leukemia division and department of hematologic oncology and blood disorders at the Levine Cancer Institute, Atrium Health, and colleagues found that financial toxicity was more likely to be reported by younger patients, black patients and those with Medicaid insurance.
“Financial toxicity is a major issue in a lot of cancer care and it appears that leukemia patients are a particularly vulnerable group,” Knight told HemOnc Today. “Our study would suggest that these issues are incredibly impactful, with concern for increased mortality in these patients. We urgently need to identify patients at risk and develop systems to help these issues and improve outcomes.”
Knight and colleagues previously reported in the Journal of Oncology Practice that patients with cancer who were affected by financial toxicity were more likely to be noncompliant with treatment (relative risk [RR] = 3.55; 95% CI, 2.53-4.98), and waive mental health care (RR, = 3.89; 95% CI, 2.04-7.45), doctor visits (RR = 2.98; 95% CI, 1.97-4.51) and medical tests (RR = 2.54; 95% CI, 1.49-4.34).
For the current study, the researchers focused on the prevalence of and risk factors for financial toxicity in patients with acute leukemia, which Knight referred to as a “lightning strike” diagnosis.
“As a researcher, I have always been interested in financial toxicity and, more specifically, how we can help patients with all of the costs and burden associated with cancer care,” he said. “However, as a leukemia and transplant physician, I see first-hand the large impact that these diagnoses have on patients and their families. You can go from living your life completely normally to suddenly being hospitalized, and best case being out of work and on intensive chemotherapy with potential need for bone marrow transplant.”
The analysis included 106 patients with acute AML or acute ALL who were treated at the Levine Cancer Institute. Among them, 54% met the criteria for exhibiting financial toxicity, which was defined as a score of 4 or less in agreement with statements, “I know that I have enough money in savings, retirement or assets to cover the costs of my treatment,” and “I am satisfied with my current financial situation.” The odds of experiencing financial toxicity were 2.7 times higher among patients younger than 65 years vs. patients aged 65 years or older; 4.3 times higher among black patients vs. white patients; and 14.2 times higher among patients with Medicaid health insurance vs. those with commercial insurance.
The results further showed that patients affected by financial toxicity had lower PROMIS global physical scores (P < .001) and mental scores (P < .001). Although not significant, there was a trend toward decreased survival among patients with financial scores fewer than 4 points.
Moving forward, Knight said the research team will initiate an interventional arm to their financial toxicity project through a grant from the Foundation for Financial Planning, a nonprofit pro bono financial planning group.
“It is our theory that if we were to address these often-overlooked issues in a systematic multidisciplinary process (utilizing physicians, nurses, pharmacists, social workers and financial counselors) that we would see not only an increase in quality of life, but that we would also see significant decreases in both morbidity and mortality,” he said. “We also hope to develop a standardized model of identification and intervention here at Levine that could be broadly applicable to other leukemia centers.” – by Stephanie Viguers
Reference:
Knight TG, et al. Abstract 4796. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.
Knight TG, et al. J Oncol Pract. 2018;doi:10.1200/JOP.18.00120.
Disclosure: Knight reports receiving funding for research assistance and help with pro bono financial counselors from the Foundation for Financial Planning.