FROM THE LANCET

Even for patients with medical insurance, multiple myeloma therapy can result in “financial toxicity.”

In a survey of 100 people receiving at least 3 months of ongoing treatment for multiple myeloma at a tertiary academic medical center, at least 70 patients “had at least a minor financial burden on account of their myeloma,” Dr. Scott Huntington of Yale University, New Haven, Conn., and colleagues wrote in an article published Sept. 17 online in the Lancet.

For 55 patients, this burden meant that they reduced spending on basic goods, 63 patients said they had reduced spending on leisure activities, 43 patients said they used savings to pay for treatment, and 21 borrowed money. Costs resulted in treatment delays according to 17 patients, and 36 patients applied for financial copayment assistance.

“Financial toxicity is prevalent in insured patients receiving treatment for multiple myeloma at an academic medical center … adversely affecting quality of life, medication adherence, and possibly even survival,” the researchers wrote (Lancet Haematol. 2015 Sept. 16. doi: 10.1016/S2352-3026(15)00151-9).

Other financial burdens may include travel expenses related to treatment and lost wages. “Half of our cohort of patients with myeloma described reductions in work hours or stopping work altogether since their diagnosis, and these individuals more commonly reported financial burden. … For our vulnerable population already at risk of lost wages and extraneous expenses, it is imperative as health care providers to confront rising treatment costs and cost sharing as means to reduce cancer-related financial toxicity,” Dr. Huntington and his associates said.

They noted that the results could suffer from selection bias because all of the respondents were from the same institution and that could reduce the generalizability of the findings, though all the patients had private insurance or Medicare with additional supplemental insurance to help with out-of-pocket expenses and had “several demographic characteristics likely to protect against financial burden compared with the general multiple myeloma population” in the United States.

The authors called for more multicenter longitudinal studies to determine the effect of treatment-related financial toxicity on clinical outcomes.

The research was funded by the University of Pennsylvania.

gtwachtman@frontlinemedcom.com

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