Risk of Financial Toxicity Shared by Caregivers and BMT Patients With Hematologic Cancer 

Higher out-of-pocket costs, prolonged hospital stays and intensive follow-up, and potential treatment-related complications increase risk of financial toxicity (FT) in patients with hematologic cancer, especially those undergoing bone marrow transplantation (BMT).  

Those same factors were also found to increase risk of FT in the caregivers of this patient population, according to a study published in Psycho-Oncology. 

FT refers to the psychological, material, and behavioral aspects of financial hardship from cancer.

Authors of the study investigated the association between FT and health-related quality of life (HRQOL) among BMT patient-caregiver dyads. The study was part of a larger single-arm, feasibility and acceptability trial of an oncology financial navigation intervention (ClinicalTrials.gov Identifier: NCT05465577).

Electronic health record data and survey responses were collected between April 2021 and January 2022 from patients undergoing BMT and their caregivers prior to (T1) and after (T2) the intervention (1-on-1 assistance with navigating costs of care from a financial navigator). The researchers anticipated finding an inverse relationship between FT and QOL in both patients and caregivers. 

A total of 34 patient-caregiver dyads completed surveys. More than half of the dyads were married couples; the other dyads involved adult children (26%), friends (12%), or some other person (38%). 

The majority of patients and caregivers were female (65% and 53%) and White (94% and 91%), respectively, with a mean age of 47 years in both groups. Most patients (64%) were covered under Medicare/Medicaid, whereas there was an even split between private insurance (46%) and Medicare/Medicaid (46%) coverage in the caregiver group. The majority of patients and caregivers had completed high school/GED and at least some college (56% and 76%, respectively). 

FT was assessed using the Comprehensive Score for Financial Toxicity (COST) and/or the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT). Patients and caregivers who scored 24 or lower on the COST scale and higher than 4 (with selection of financial or insurance issues on “Problems” list) on the DT scale were considered positive for FT.  

The researchers reported that the majority of patients and caregivers (85% in both groups) scored 24 or lower on the COST scale; on the DT scale, 61% and 55%, respectively, scored higher than 4 and selected financial or insurance issues on the “problems” lists. These scores indicate FT in both groups.

The effect of the total FT score — the combination of psychological response, coping behaviors, and material conditions domain scores — on physical health, mental health, anxiety, depression, and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM).

APIM modeling measures actor and partner effects. Actor is the effect of the patient’s or caregiver’s demographics and FT indicators on themselves, whereas partner is the effect of these factors on the other member of the dyad.

Patients and caregivers with lower total FT scores had better physical and mental health, less anxiety and depressive symptoms, and less distress (APIM actor effects). None of the partner effects were significant.

Other APIM model findings indicated patients reported worse physical health than did their caregivers; all participants reported higher mental health scores at T2, on average, compared with T1; and dyads whose caregiver took time off from work reported better physical health and lower depressive symptoms and distress than those whose caregivers did not.

“Screening both patients and caregivers for psychosocial distress, specifically FT along the cancer care continuum, is key to early identification and intervention,” the researchers suggested.

Additional recommendations include engaging in patient/caregiver-provider cost-of-care conversations and connecting patients and caregivers with oncology financial navigators and/or social workers.

“Healthcare team members must be knowledgeable about connecting patients/caregivers to financial assistance resources, both internal and external to the health system,” they concluded.