Most Patients with Multiple Myeloma Face Financial Toxicity

Money

Regardless of insurance status, patients with multiple myeloma can expect financial hardships—even those making over $100,000 a year, according to a study published online in Lancet Haematology.

Researchers from Penn Abramson Cancer Center conducted a cross-sectional survey of 100 patients receiving at least 3 months of ongoing treatment for multiple myeloma between August 2014 and January 2015. All participants were insured; those with Medicare fee-for-service coverage also had additional supplemental insurance to help with out-of-pocket expenses, and 18% reported household incomes over $100,000.

Still, 70% indicated experiencing at least minor financial toxicity.

Nearly half of the respondents reported having to tap into their savings to cover their care, 21% borrowed money to pay for medications, 17% said they delayed treatment because of cost, and 10 patients stopped treatment altogether.

The authors attributed the rising costs to the extended duration of multiple myeloma treatment as well as the increasing costs of newly approved blood cancer therapeutics, which can be priced at $10,000 or more a month.

“While advances in multiple myeloma therapy have contributed to significant improvements in patient outcomes, the clinical gains have come with rising costs,” lead author Scott Huntington, MD, formerly of the division of Hematology/Oncology at Penn who is now a faculty member at Yale University, said in a statement. “And today, because of these advances, most patients are on a new drug, compared to a decade ago when less than 5% were.”

Of the patients surveyed, 59% said that treatment costs were higher than they expected, 36% applied for financial assistance, and more than half reported reducing their work hours or quitting since their diagnosis.

The participants had an education level above national average, the median age was 64, and 53% were female. The median annual household income was between $60,000 and $79,999, and 70% of patients reported having some college education.

For the study, investigators used the COST (Comprehensive Score for Financial Toxicity) questionnaire to measure aspects of financial circumstances including income, education, marital status, ability to work, and opinions about additional expenses and current financial situation.

Based on the COST scores, being younger, unmarried, and having a lower household income ($40,000-79,999) were associated with higher financial burden.

The researchers concluded that more attention to rising treatment costs and cost sharing is needed to address financial toxicity among patients with cancer.

“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 noted. “In the interim, strengthened collaboration among patients and healthcare stakeholders is needed to promote healthcare reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”

Huntington SF, Weiss B, Vogl DT, et al. Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study [published ahead of print September 17, 2015]. Lancet Haematol. doi: 10.1016/S2352-3026(15)00151-9.