Financial Burden May Lead to Delayed Care in Patients with CLL

Patients with cancer may experience financial burden due to medical expenses, job disruption/loss, and other factors. Financial burden may ultimately affect cancer-care decisions and possibly lead to delayed treatment and appointments, which could have an impact on physical and mental quality of life (QOL). A study found that financial burden was significantly associated with postponing care and poorer QOL in patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). The results of the study were presented at the 62nd ASH Annual Meeting & Exposition.

Patients responded to the Cancer Support Community’s online survey, the Cancer Experience Registry, providing information on financial burden (eight items; yes/no response), postponing care (six items; five-point Likert scale), and QOL, which was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS-29v2.0) subscales (anxiety, depression, physical function, and fatigue) with transformed T scores.

Final analysis consisted of 435 patients with CLL (28%) and MM (72%). Mean age was 62 years, and 88% of the cohort was white. Mean time since diagnosis was 5.2 years. Among the patients with CLL, 28% had Rai stage 3-4 disease.

Overall, 21% of patients had an annual income <$40,000; 22% reported spending >$500 and 23% >$250 in monthly out-of-pocket (OOP) costs to cover cancer care. Patients reported that to pay for their cancer care, they had depleted their savings (29%), borrowed against or used money from a retirement plan (19%), liquidated assets (13%), collected unemployment insurance (7%), took an extra job (4%), chose a less effective treatment (4%), cashed in a life insurance policy early (4%), and had their house foreclosed (2%).

Two-thirds of patients said that no one from their healthcare team discussed costs with them, even though 41% of patients were moderately to very seriously concerned about health insurance or money. When asked whether they sometimes, often, or always engaged in behaviors related to postponing care, patients reported that they postponed psychological counseling or support (16%), doctor’s appointments (12%), filling prescriptions (6%), or follow-up screening or bloodwork (5%); skipped dosages of prescribed drugs (5%); and delayed complementary treatment including therapy (12%).

Factors associated with financial burden included age (standardized path coefficient β=-0.17), low income (β=0.24), OOP costs (β=0.18), time since diagnosis (β=0.11), and advanced stage disease (β=0.17); financial burden had a significant impact on postponing care (β=0.40). Financial care also had a direct (β=-0.17) and indirect (β=-0.10) impact, through postponing care, on physical QOL, as well as emotional QOL (β=0.15 and β=0.12, respectively).

The study authors concluded, “[Patients with] MM and CLL may benefit from access to no- or low-cost preventative and supportive psychosocial care, as well as financial counseling and assistance with health care team communication.”