Financial Toxicity Intervention Improves Outcomes in Patients With Hematologic Malignancy

Thomas Gregory Knight · Melissa Aguiar · Myra M Robinson · Allison Morse · Tommy Chen · Rupali Bose +8 more

59 citations0/0 files storedJCO Oncology Practice

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Economic and Financial Impacts of Cancer Cancer survivorship and care Food Security and Health in Diverse Populations

Abstract

PURPOSE: Patients with hematologic malignancies are extremely vulnerable to financial toxicity (FT) because of the high costs of treatment and health care utilization. This pilot study identified patients at high risk because of FT and attempted to improve clinical outcomes with comprehensive intervention. METHODS: All patients who presented to the Levine Cancer Institute's Leukemia Clinic between May 26, 2019, and March 10, 2020, were screened for inclusion by standardized two question previsit survey. Patients screening positive were enrolled in the comprehensive intervention that used nurse navigators, clinical pharmacists, and community pro bono financial planners. Primary outcomes were defined as improvement in mental and physical quality of life in all patients and improvement in overall survival in the high-risk disease group. RESULTS: One hundred seven patients completed comprehensive intervention. Patients experiencing FT had increased rates of noncompliance including to prescription (16.8%) and over-the-counter medications (15.9%). The intervention resulted in statistically significantly higher quality of life when measured by using Patient-Reported Outcomes Measurement Information System physical (12.5 ± 2.2 v 13.7 ± 1.8) and mental health scores (11.4 ± 2.2 v 12.4 ± 2.2; all P < .001). In patients with high-risk disease (as determined by using disease-specific scoring systems), risk of death in those receiving the intervention was 0.44 times the risk of death in those without the intervention after adjusting for race, and treatment with stem-cell transplant, oral chemotherapy, or immunotherapy (95% CI, 0.21 to 0.94; P = .034). CONCLUSION: Screening and intervention on FT for patients with hematologic malignancies is associated with increased quality of life and survival.

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2009Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items 2005Detecting and monitoring depression with a two-item questionnaire (PHQ-2)2013The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient's Experience 2016Measuring financial toxicity as a clinically relevant patient‐reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST)2016Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer 2018The financial burden and distress of patients with cancer: Understanding and stepping‐up action on the financial toxicity of cancer treatment 2016Financial Hardships Experienced by Cancer Survivors: A Systematic Review 2014The development of a financial toxicity patient‐reported outcome in cancer: The COST measure

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