Multiple Myeloma Patients at Higher Risk for Financial Toxicity

Excessive out-of-pocket costs can become an adverse event from treatment.

Out-of-pocket costs is a topic of much concern for patients and physicians alike, but for patients with multiple myeloma the effects of these expenses may be even worse.

Financial toxicity due to the higher use of novel therapeutics and extended duration of myeloma treatment is a burden many patients with the disease have to bear. In a study by Penn’s Abramson Cancer Center, nearly half of the 100 patients surveyed tapped into their savings accounts to help pay for their care, and 17% reported delays in treatment due to high costs. Ten stopped treatment altogether.

Financial toxicity describes the financial burden out-of-pocket costs pose to patients, which can affect their wellbeing and become an adverse event of treatment. Past studies have shown how these costs can affect patient adherence to treatment, as well as quality of life and increases in mortality.

“While advances in multiple myeloma therapy have contributed to significant improvements in patients outcomes, the clinical gains have come with rising costs,” said Scott Huntington, MD, formerly of the division of Hematology/Oncology at Penn who is now a faculty member at Yale University. “And today, because of these advances, most patients are on a new drug, compared to a decade ago when less than 5% were. So we’re not talking about a select group of patients faced with this burden — many are facing the financial challenges with treatment.”

Costs of newly approved blood cancer therapeutics have increased 10 fold in the past 15 years, with many treatments priced at $10,000 or more per month.

The team used the Comprehensive Score for Financial Toxicity (COST) questionnaire to survey participants in the study. The COST tool measures various aspects of financial circumstances, such as income, education, marital status, ability to work, and overall opinions about additional expenses and their current financial situation.

Of the 100 participants surveyed, 59% reported multiple myeloma treatment being more expensive than anticipated and 70% indicated at least minor financial burden. Additionally, 36% reported applying for financial assistance, which included 18% who reported incomes over $100,000.

Forty-three percent of participants used savings as a method of payment and 21% borrowed money to pay for medications. Seventeen percent reported delays in treatment due to the costs. More than 50% of participants had to quit their jobs or reduce their hours due to their diagnosis. Ten patients discontinued treatment due to the high costs.

The most surprising finding of the study was the fact that it included participants who reported higher incomes, as well as other factors that would normally indicate no financial burden. All participants were insured and all patients with Medicare fee-for-service coverage had additional supplemental insurance to assist with out-of-pocket costs.

Additionally, the median household income and education level of the participating patients was above the national average. The median household income was reported between $60,000 and $79,999, with 70% having some college education.

“While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients,” the authors wrote. “In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”