Financial Toxicity Seen in 3 of 4 HSCT-Eligible Patients With Leukemia

Nearly 3 in 4 patients with leukemia who are eligible for hematopoietic stem cell trans- plantation (HSCT) report financial distress, found a systemic review of studies assessing financial burden among the patient population.

The researchers of a new review, published in Best Practice & Research Clinical Haematology, highlighted the unique financial burden facing these patients, who often require lengthy hospitalizations and have associated risk of acute and chronic morbidity.

In one study of 268 patients, 73% reported feeling a financial burden from their disease. Nearly half (47%) reported experiencing significant decreases in income, needing to sell their home, or taking money out of their retirement funds at a median follow-up of 2.3 years following their transplant. Notably, most patients were insured; in general, patients who undergo HSCT tend to be deemed fit both medically and socially for the procedure, explained the researchers.

“Many of the barriers to transplant include financial barriers, including no insurance or underinsurance, lower educational status (which is itself linked to higher financial burdens), and lower overall income,” detailed the group. “Taken together, these data indicate that the financial distress described above likely represents an underestimate of the true burdens and further suggests the real clinical consequence of financial distress, especially as HSCT is the only known curative therapy for intermediate- and high-risk acute leukemias.”

Findings from multiple studies included in the analysis showed that younger adults, in particular, were burdened by financial costs. One study that surveyed over 1100 patients receiving a transplant found that younger and middle-aged adults faced a higher risk of financial distress than older adults. A second survey study had similar findings, also showing that patients with poor mental health or physical function were more likely to face financial distress.

The researchers noted that these findings are consistent with those found in the cancer community at large, likely due to reductions in income from missing work and less savings compared with older adults, who had more savings and were often retired.

Missing work was commonly found in the studies, with multiple studies finding that over half (53%-64%) of patients were able to return to work within study follow-up, which was a minimum of 2 years.

Various groups of researchers have urged use of universal screening among patients for financial distress. To date, tools for measuring financial distress in these patients have been limited to a combination of validated survey tools, including the Comprehensive Score for Financial Toxicity survey and individual questions that focus on the impact of disease on finances, paying monthly bills, and depletion of financial resources.

Some groups have tried to create a simple and short validated tool to measure toxicity. One group found that capturing age, money owed, and copayment-related concerns yielded a sensitivity rate of 89% and negative predictive value of 96% for determining financial toxicity.

Other interventions include educational interventions for patients, adoption of a tumor board focused on financial toxicity, and financial navigation programs.

“Further research is needed to determine which existing [financial toxicity] interventions are most effective and to develop novel approaches to decrease the financial burden of cancer on these patients,” commented the researchers. “It is important to note that all the studied interventions covered in this review, and within the cancer community at large, are focused on institution-specific interventions. The roles of these interventions are inherently limited as many of the drivers of financial toxicity are structural and warrant public policy approaches to exert a sizeable impact.”

Reference

Pail O, Knight T. Financial toxicity in patients with leukemia undergoing hematopoietic stem cell transplantation: a systematic review. Best Pract Res Clin Haematol. Published online April 19, 2023. doi:10.1016/j.beha.2023.101469