American Society of Hematology Annual Meeting

Financial Toxicity High With Myeloma, Navigation May Help Find Aid, Solutions

Avatar photoBryant Furlow
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The high cost of CAR-T therapy concerns patient advocates who worry about the "financial toxicity" i
The high cost of CAR-T therapy concerns patient advocates who worry about the “financial toxicity” i
A pilot project at a Philadelphia cancer center sought to improve awareness of financial assistance resources for patients with multiple myeloma.

Most patients with multiple myeloma (MM) face serious financial hardship from treatment costs, even when they have health insurance, according to research presented at the ASH Annual Meeting 2023. But it remains unclear how best to address the problem.

Many patients are not aware of cancer centers’ financial support services, most do not apply for copayment assistance, and patients are unlikely to discuss treatment costs with their oncologists, noted lead study author Mia Djulbegovic, MD, MS, of the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center in Philadelphia. 

“Although financial support services exist, they’re haphazardly accessed,” Dr Djulbegovic said. “Financial support services focus mostly on medical bills and include a limited evaluation of outpatient drug costs; this remains an unmet need.”

Patients with MM are at particular risk of financial toxicity. “On one hand, they’re living longer despite having an incurable disease. But on the other hand, this means requiring lifelong and often expensive medical treatments,” she explained.

Typical frontline MM treatments can cost up to $600,000 a year, Dr Djulbegovic noted.

Yet relatively little is known about how best to identify patients at risk of financial toxicity and connect them to support services or interventions to help alleviate it. So, Dr Djulbegovic and her coauthors developed and assessed the effectiveness of a nurse navigator-led financial navigation program in a randomized, controlled single-center intervention study.

They recruited adult patients with MM receiving systemic treatment at the Abramson Cancer Center during follow-up appointments. Participants completed the validated Comprehensive Score for Financial Toxicity (COST) questionnaire, which yields a numeric score of 0 to 44, with lower scores indicating more financial burden. 

Patients with COST scores of less than 26 points are deemed at risk of financial toxicity. Eighty-three evaluable at-risk patients were included in the analysis: 41 in the Financial Navigation Program (FNP) intervention group and 42 in the usual-care control group. Patients in the FNP group received financial advocacy and social work referrals, a coordinated action plan, and monthly phone follow-up by a nurse navigator. 

The primary study endpoint was change in COST score. Secondary endpoints were health-related quality of life (measured with the Functional Assessment of Cancer Therapy [FACT-G] scale) and patient satisfaction (measured with the Patient Satisfaction Questionnaire Short Form [PSQ-18]).

The groups were well balanced for age, gender, race, and ethnicity, although the intervention group participants tended to have higher incomes (54% earned more than $60,000 a year vs 38% in the control group). 

“On average, patients were aged 65 years, half were female, and 39% were non-White,” Dr Djulbegovic said.

Study limitations included the fact that all participants were English speakers and literate, and all were insured. Importantly, many had enrolled in financial support services prior to study participation. So many participants faced no out-of-pocket pharmacy costs. (Costs were self-reported by patients and not objectively corroborated, Dr Djulbegovic noted.)

Navigation program participation improved patients’ understanding of financial support services and those in the FNP group completed a financial assistance application during the study at a rate nearly 3 times higher than the control group (34% vs 12%; P <.02).

However, at a median follow-up period of 4.9 months, compared with the control group, FNP interventions were not associated with statistically significant improvements in FACT-G quality of life scores or PSQ-18 patient satisfaction scores. 

Improvements in COST scores did not reach statistical significance, perhaps in part because of some participants’ utilization of financial support services prior to study enrollment.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Djulbegovic M, Doherty M, Fanslau K, et al. Assessing the impact of a financial navigation program for patients with multiple myeloma: a randomized controlled trial. Presented at ASH 2023. December 9-12, 2023. San Diego, CA. Abstract 909.