Patients with multiple myeloma are at a higher risk of facing financial burdens due to treatment costs; however, financial support services may be accessed at random, according to Dr. Mia Djulbegovic.
These financial burdens, referred to as financial toxicity, describe harmful effects caused by higher costs of treatment, which ultimately affect a person’s quality of life, a study from JAMA Network defined.
Results from a trial, designed to evaluate the outcomes of a financial navigation program, were presented by Djulbegovic at the 2023 American Society of Hematology Annual Meeting.
“On one hand, (patients with multiple myeloma are) living longer, despite having an incurable disease. But on the other hand, this means requiring lifelong and often expensive medical treatments,” Djulbegovic, division of hematology-oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, said during a presentation of the results.
“Therefore, there remains a critical need to develop and evaluate pathways that not only identify patients who are at risk of financial toxicity but also connect them to the interventions that can reduce this burden.”
The investigators recruited adult patients with multiple myeloma who underwent systemic treatment at the University of Pennsylvania during their follow-up appointments.
In total, 193 patients consented to take the Comprehensive Score for Financial Toxicity (COST) survey — an 11-item, validated measure of financial toxicity risk. The scores ranged from 0 to 44. Patients also completed a baseline survey to assess socioeconomic and demographic factors, cost-coping behaviors, quality of life and satisfaction. After 4 months, they completed a similar final survey.
Patients at risk for financial toxicity (COST score, <26) were evenly randomized to receive financial intervention or usual care.
In total, 53 patients comprised both arms, with 41 included in the intervention analysis and 42 in the usual care group.
The mean age was 64.8 years, while most patients were female (53%) and 39% were non-White. Further, most patients in the entire cohort finished college (49%), made less than $60,000 (46%) and were insured with Medicare (58%). Lastly, 64% claimed to have used prior financial support services.
The financial navigation program aimed to proactively identify patients at risk of financial toxicity, comprehensively assess their needs, methodically connect them to resources and follow them to ensure their needs were being met.
As part of the program, nurse navigators assessed financial and transportation barriers to care by telephone. They then performed proactive outreach to financial advocates and social workers, while coordinating resources for the patients. This was then followed by monthly follow-up calls with the patients.
The primary outcome of the study was a change in COST score, while secondary outcomes included cost-coping behaviors, quality of life as measured by the Functional Assessment of Cancer Therapy (FACT-G) and satisfaction as measured by the Patient Satisfaction Questionnaire Short Form (PSQ-18).
After a median follow-up of 4.9 months, 95% of patients participated in the financial navigation program and 68% completed three or more follow-up calls. In the usual care group, 17% had received financial support services.
Djulbegovic noted that the financial navigation program improved patients’ understanding of financial support services and reduced stress. “We also found in this study that financial support services focus mostly on medical bills and include a limited evaluation of outpatient drug costs. So, this remains an unmet need,” she added.
When looking at patient-reported outcomes, the impact on patients applying for financial assistance was statistically significant with the financial navigation program, versus usual care (23% versus 12%).
“We found that a proactive and coordinated financial navigation program, while resource intensive, is efficient and scalable. It demonstrates high retention and leads to an increase in financial assistance applications,” Djulbegovic said.
She acknowledged that the study was limited by its participants, who were English-speaking and literate only, and all insured. Further, it was limited because it was survey- and telephone-based, and there were no objective data.
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