How Prevalent Are Financial, Time Toxicity in Patients with Multiple Myeloma?

Financial toxicity occurred in nearly one-quarter of patients with multiple myeloma (MM) and 39% experience time toxicity, according to research presented at the 20th International Myeloma Society Annual Meeting and Exposition.

Rahul Banerjee, MD, of the Fred Hutchinson Cancer Center, and colleagues conducted the research. They aimed to characterize financial and time toxicity because patients with MM “may be at ongoing risk of financial toxicity from medication costs and lost productivity” and time toxicity from “frequent health care interactions may persist into the maintenance phase of therapy.”

Dr. Banerjee and colleagues conducted a cross-sectional survey of 576 patients with MM who received autologous hematopoietic stem cell transplantation (AHSCT) at one institution in the United States. The survey included the validated FACIT-COST inventory of financial toxicity, questions about financial fragility, as well as questions about symptoms and the frequency and nature of health care interactions.

The researchers defined financial toxicity as a FACIT-COST score in the lowest quartile, which was 25 or less. They defined time toxicity as MM-related health care interactions—including telehealth and phone calls—that averaged at least one time a week, or in-person MM-related interactions that averaged at least once a month with each interaction requiring at least four hours away from home, including transit time.

Dr. Banerjee and colleagues conducted multivariate logistic regression using age, years after AHSCT, caregiver status, insurance, income, and MM status as covariates.

Of the 576 eligible patients who received the survey, 205 (36%) completed it. Most patients (62%) who completed the survey were on maintenance therapy, with 22% on observation, and 16% on treatment for relapsed MM. The median patient age was 68 years, with a median of three years since AHSCT.

The median FACIT-COST score was 31 (interquartile range, 25 to 37). Nearly one-quarter (24%) of patients had financial toxicity, 39% had time toxicity, and 12% had financial toxicity and time toxicity.

Nearly one-third (32%) of patients on maintenance therapy reported financial toxicity. Financial toxicity was reported by 26% of patients on observation and 23% of those with relapsed MM.

Financial toxicity was associated with increased anxiety, depression, and fatigue (P<.01 in all cases) in univariate analyses. It was also associated with “skipping essential items/medications and financial fragility,” according to Dr. Banerjee and colleagues. Younger age (odds ratio [OR]=1.09; P=.01) and income below $50,000 (OR=3.43; P<.01) were both predictors of financial toxicity in multivariate analyses.

Nearly all (87%) patients with relapsed MM reported time toxicity. Time toxicity was reported by 35% of patients on maintenance and by 11% of those on observation.

In the patients experiencing time toxicity, 58% reported any-type MM interactions occurring at least once a week, with 25% reporting in-person MM visits with long transit times occurring at least once a month, and 16% reporting both.

Time toxicity was associated with increased fatigue in a univariate analysis (P=.01). Multivariate analyses showed the only predictor of time toxicity was relapsed disease status (OR=8.85, P<.01).

“[Financial toxicity] was associated with increased symptom burden and financial fragility, and better support of out-of-pocket costs through post-[AHSCT] maintenance and relapse may be helpful,” Dr. Banerjee and colleagues concluded. “[Time toxicity] was reported by over a third of [patients] on maintenance, and de-escalation of low-yield monitoring during this phase of survivorship should be considered. To our knowledge, this is the largest study to date of [financial toxicity] and [time toxicity] in MM.”

Reference

Banerjee, R, et al. Financial toxicity and time toxicity among patients with multiple myeloma. Abstract P-452. Presented at the 20th International Myeloma Society Annual Meeting and Exposition. September 27-30, 2023; Athens, Greece.