Financial Intervention Decreases Mortality in Patients with Hematologic Malignancy

Patients with cancer often face financial toxicity due to the effects of disease on the ability to work, as well as the costs of treatment. According to research presented at the all-virtual 62nd ASH Annual Meeting & Exposition, an intervention to address financial toxicity can decrease mortality in patients with high-risk hematologic malignancy.

“Patients with high-risk hematologic malignancies represent an especially vulnerable group for cost-related issues due to heavy healthcare utilization, high costs associated with their treatment, and the potentially deadly consequences of treatment non-compliance,” said lead presenter Thomas G. Knight, MD, of the Levine Cancer Institute at Atrium Health in Charlotte, NC. “We hypothesized that comprehensive intervention on the financial aspects of care for these patients would lead to decreased mortality.”

Over a six-month period, Dr. Knight and colleagues surveyed 105 adult patients who were being seen in the Department of Hematologic Oncology and Blood Disorders for a high-risk hematologic malignancy, including acute myeloid leukemia, acute lymphocytic leukemia, myelodysplastic syndromes, chronic myeloid leukemia, or mixed phenotypic acute leukemia.

The survey included the PROMIS Global-10, a 10-question survey used to assess healthcare-related quality of life, as well as two 0-10 scale items from the Comprehensive Score for Financial Toxicity (COST) tool:

  • “I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment.”
  • “I am satisfied with my current financial situation.”

The researchers defined financial toxicity as a score of five or lower on the COST items. Patients with financial toxicity were invited to participate in the intervention, which consisted of:

  • An appointment with a nurse navigator, during which the patient completed a worksheet to identify gaps in care and possible funds or financial assistance
  • An appointment with a clinical pharmacist to review medication copays and possible assistance programs
  • Services from a financial planner for help with budgeting, asset management, and general finances

The researchers then tracked clinical outcomes and overall survival (OS). Of the 105 eligible patients, 59 (56.2%) scheduled and received the full intervention. The rest of the patients received standard care. The groups were similar with respect to gender, race, age, marital status, insurance type, financial toxicity scores, treatments received, and disease type.

Mortality among the patients who did not receive the intervention was 43%, but mortality in the intervention group was 27%.

Adjusted OS at six months were 81.4% for those receiving the intervention and 73.9% for those not receiving the intervention. At 12 months, OS rates were 73.0% and 46.4%, respectively. When the researchers adjusted for other factors, such as insurance coverage, race, and age, they found that risk of death in those receiving the intervention was 0.47 times the risk of death in those who did not receive it.