Multiple Myeloma Patients May Be More Vulnerable to Financial Toxicity

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The latest studies are suggesting that financial toxicity is increasingly a problem in the United States and may be significantly adversely affecting the quality of life and medication adherence in cancer patients.

Now, a new study published in Lancet Haematology is suggesting that patients with multiple myeloma (MM) may be particularly vulnerable because of high use of novel treatments and extended treatment duration.¹

“While advances in multiple myeloma therapy have contributed to significant improvements in patients outcomes, the clinical gains have come with rising costs,” said study investigator Scott Huntington, MD, who is formerly with the division of Hematology/Oncology at Penn State University and now a faculty member at Yale University, New Haven, Conn.²

Dr. Huntington and his colleagues have found that even MM patients with health insurance may be vulnerable to financial toxicity, including those who make over $100,000 a year. The researchers used the COST (Comprehensive Score for Financial Toxicity) questionnaire among other survey questions. The COST tool measures various aspects of financial circumstances, including income, education, marital status, and ability to work. The team conducted a cross-sectional survey of MM patients receiving at least 3 months of ongoing treatment at a tertiary academic medical center. The patients were surveyed between August 18, 2014, and January 7, 2015.

Out of the 100 patients who took part in the study, 59% labelled MM treatment costs as higher than expected. In addition, the researchers found that 70% indicated at least minor financial burden and 36% percent reported applying for financial assistance. Interestingly, some of these patients reported incomes over $100,000. However, the findings are not surprising because the cost of newly approved blood cancer therapeutics have increased 10-fold in the past 15 years. Some new agents are priced at $10,000 or more a month.

The study found that 43% of those MM patients surveyed had to use their savings to pay for their care and 21% had to borrow money to pay for medications. The study also showed that 17% reported delays in treatments due to costs. More than half had to reduce their hours at work or quit since their diagnosis, and 10 patients stopped treatment altogether due to high costs.

This study is notable because it included patients with demographic characteristics likely to protect against financial burden. All participants were insured and all patients with Medicare fee-for-service coverage had additional supplemental insurance to assist with out-of-pocket costs. They also had a median household income and education level above national average. The median age was 64 and 53% were female. The median annual household income was reported between $60,000 and $79,999, and 70% reported having some college education.

“Most patients are on a new drug compared to a decade ago when less than 5% were. So, we’re not talking about a select group of patients faced with this burden. Many are facing the financial challenges with treatment,” said Dr. Huntington.

He and his team write that it is time to acknowledge “the untenable rise in treatment costs” and they believe oncologists can no longer ignore the impact on patients. They urge clinicians to work with their patients to promote health care reforms.

References:

• Huntington SF, Weiss BM, Vogl DT, et al. (2015). Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. The Lancet Haematology.
• Penn Medicine News Release. (2015). Multiple Myeloma Patients More Vulnerable to 'Financial Toxicity' Due to Expensive, Longer Courses of Treatments, Penn Study Finds.