Financial Burden of Multiple Myeloma High, Even Among Insured

Seventy percent of insured patients with multiple myeloma had treatment-related financial burden, including some with household incomes greater than $100,000 a year, according to the results of a survey published in Lancet Haematology.

“The results of our study suggest that insured patients with myeloma in the USA frequently have treatment-related financial burden and use strategies to cope with high out-of-pocket costs,” wrote researchers led by Scott F. Huntington, MD, of the Abramson Cancer Center in Philadelphia. “Rising costs of treatment and increased cost sharing are barriers to the provision of high-quality cancer care, and increased engagement by patients and health-care stakeholders is needed.”

Huntington and colleagues surveyed 100 people who received at least 3 months of treatment for myeloma. The survey included the 11-item COST measure, which provides a financial toxicity score from 0 to 44, with lower values indicating greater financial burden. Participants completed the survey before and after their clinic visit. The median age of participants was 64 years and participants had a median household income of between $60,000 and $79,999 a year. All patients had health insurance.

The researchers found that participants commonly reported the use of coping strategies to balance the high out-of-pocket costs of treatment related to their disease.

Fifty-nine percent of surveyed participants reported that treatment costs were higher than they expected. Seventy-one percent of patients reported at least minor financial burden.

Just fewer than half of surveyed patients reported using their savings to pay for myeloma treatment with 21% reporting having had to borrow money to pay for medications.

In addition, the survey found that 36% of participants reported having to apply for financial assistance, including six patients who had household incomes of more than $100,000 per year. Overall, 17% of patients had treatment delays because of cost.

The mean COST score was 23 and the median was 23.5. COST scores were associated with patient-reported use of strategies to cope with myeloma treatment expenses.

“Patients with COST scores of less than the median (increased financial toxicity) were more likely to report reduced spending on basic goods and leisure activities, use of savings for cancer care, borrowing money to pay for treatment, a delay in treatment initiation for financial reasons, and stopping myeloma treatment because of cost than were those with scores of greater than the median,” the researchers wrote.

A multivariable analysis showed that younger age, non-married status, longer duration from diagnosis, and lower household income were associated with higher COST-measured financial burden.

“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,” the researchers wrote. “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.”