Financial toxicity and quality of life in patients undergoing bone marrow transplant evaluation: A single center analysis.

Abstract

7052 Background: The impact of pre-transplant financial toxicity on quality of life (QOL) outcomes following bone marrow transplant (BMT) is unknown. We investigated the prevalence of financial toxicity in a population undergoing evaluation for BMT and its impact on post-transplant clinical and health-related QOL outcomes. Methods: This is a cross-sectional study in patients undergoing evaluation for allogeneic BMT between 1/1/2018 and 9/23/2020 at a large academic medical center. Financial health at baseline was measured via the comprehensive score for financial toxicity (COST) survey. The cohort was divided into three groups: none, mild, and moderate-high financial toxicity. QOL was measured using Functional Assessment of Cancer Therapy (FACT)-based questionnaires at multiple timepoints. Multivariate logistic regression analysis evaluated factors associated with financial toxicity. Kaplan-Meier curves and log-rank tests evaluated overall survival and non-relapse survival. Results: Of 245 patients evaluated for BMT, 176 (71.8%) completed both questionnaires with 63.1% male, 72.2% white, and median age 57 years. Common diagnoses were myelodysplastic syndrome (39.2%), leukemia (38.1%), and lymphoma (13.6%). Overall, 83 (47.2%) patients reported no financial toxicity, 51 (29.0%) mild, and 42 (23.9%) with moderate-high financial toxicity at initial evaluation for BMT. Compared to those with no financial toxicity, those with mild or moderate-high financial toxicity reported significantly reduced spending on leisure, food/clothing, used all or a portion of savings, borrowed money or accumulated debt using a credit card, and did not fill a prescription due to costs (p < 0.0001 for all). In patients with baseline moderate-high financial toxicity, FACT-BMT scores were lower at 6 months (126 none vs 122 mild vs 92 moderate-high; p = 0.0007) and 1 year (133 none vs 117 mild vs 112 moderate-high; p = 0.0075) following BMT. Older age (>62) (OR 0.4; 95% CI [0.17 – 0.94], p = 0.03) and income equal or greater than $60,000 (OR 0.16; 95% CI [0.07 – 0.36], p = < 0.001) were associated with lower odds of financial toxicity. No association was noted between financial toxicity and selection for BMT, overall survival, or non-relapse mortality. Conclusions: Financial toxicity was highly correlated with patient-reported changes in behavior affecting their daily activities and transplant care, with notable impact on QOL following transplant for up to 1 year. Early interventions by physician and social work-led teams may benefit patients who are at risk for financial toxicity. [Table: see text]