Financial Toxicity Worsens HRQOL in Blood Cancers, Even With Universal Health Care 

Financial toxicity (FT) was associated with worse health-related quality of life (HRQOL) in patients receiving treatment for hematologic malignancies in a universal health care system, compared with those with no FT. These findings were published in JCO Oncology Practice.

This association between financial toxicity and worse HRQOL has been reported in studies primarily comprising patients with solid tumors who were living in the United States, which does not have universal health care.

To assess the effects of financial toxicity among patients with hematologic malignancy in a universal health care setting, data were sourced from 6 multicenter studies conducted by the Italian Group for Adult Hematologic Diseases (GIMEMA). 

Patients with hematologic malignancy were assessed for financial toxicity and HRQOL using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).

This analysis included 1847 patients; median age 67.2 years; 55.5% were men; and 30.6% had chronic myeloid leukemia (CML), 27.8% had myelodysplastic syndrome (MDS), 21.8% had relapsed refractory multiple myeloma (RRMM), and 19.8% had acute promyelocytic leukemia (APL). 

Almost 1 in 4 patients (441 [23.9%]) analyzed for this study reported FT. These patients had lower educational attainment and fewer were receiving a salary. They also had worse performance status and more had comorbidities at baseline, compared with those in the non-FT group (all P ≤.043).

Those in the FT group had significantly lower physical, role, emotional, cognitive, and social functioning scores. They also reported higher fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea scores than those in the non-FT group (all P <.001).

In the multivariate analysis, FT was associated with performance status of 1 or higher (odds ratio [OR], 1.66), 1 or more comorbidities at baseline (OR, 1.27), not receiving a salary (OR, 0.60), and a diagnosis of MDS (OR, 0.72) or CML (OR, 0.44) compared with RRMM.

“[T]he use of the financial difficulties item of the EORTC QLQ-C30 questionnaire for measuring FT has allowed us to use established thresholds for defining clinically important financial difficulties,” the study authors noted.

Additionally, this study demonstrated that FT is a relevant issue in patients with hematologic malignancies, even for those treated in a universal health care system.