Financial toxicity of hematologic malignancy therapies: Subjective experience of patients and impact on access to care.
Authors: Fedorov Kateryna , Amaeshi Lemchukwu , Mathew Rosmi , Levitz David , Cole Daniel , Sisto Alex , Singh Kuldip , Fehn Kareh , Kim Mimi , Liu Jianyou , Wright Karen , Goldfinger Mendel , Mantzaris Ioannis , Sica Alejandro R. , Cooper Dennis , Konopleva Marina , Verma Amit , Rapkin Bruce , Shastri Aditi , Shah Nishi 
Published: June 2023

e18907

Background: Financial toxicity is an increasingly recognized challenge in cancer care delivery due to the costs of cancer treatment. Increased burden of financial toxicity is associated with poor quality of life and is a healthcare barrier for patients from underserved communities. Here we report on degrees of financial toxicity in patients from socioeconomically disadvantageous and predominantly minority backgrounds undergoing treatment for hematologic malignancy. Methods: This is a prospective ongoing survey-based study from Montefiore Cancer Center, Bronx, NY, that included patients with new diagnosis (ND) of hematologic malignancy and those undergoing cellular therapies (CT) such as CAR-T and autologous/allogeneic stem cell transplant. The study employs two surveys: COST-FACIT and investigator-designed surveys for a total of 25 questions. Surveys are administered on Days 0, 30, and 90. Results: At the time of data cut-off, thirty-six patients were included in the data analysis: 22 in ND cohort and 14 in CT cohort. The median age of patients in the ND cohort was 50.1 (29.2-75.2) years old; 8/12 (67%) were African American (AA), 8/17 (47%) identified as Hispanic (H). Patients in the CT cohort were older, with a median age of 57.7 (31.7-80.1) years old; 9 (64.3%) were male; 4/7 (57%) were AA, 8/8 identified as H. At the time of Day 0 survey, 50.0% of ND cohort were classified as having moderate to severe financial toxicity. 19.0% of patients were not employed, 4.8% were on disability, with 27.3% having difficulty paying for food, heating, and warm clothes. 13.6% reported disruptions to their daily life due to emotional distress. 83.3% of patients did not delay seeking medical care due to financial difficulties while 9.5% reported missing or delaying treatments due to not being able to pay for medications. In CT cohort, at the time of Day 0 survey, 57.1% patients were classified as having moderate financial toxicity. Only 16.7% patients were unemployed, 33% were on disability. The proportion of patients with difficulties paying for food, heating, and warm clothes was comparable to that in the ND cohort (21.4%). 64.3% of patients sought medical care without delays, while 7.7% missed or delayed treatments due to financial strain. In the ND cohort, 11 of 22 patients completed Day 30 survey; 6 of 11 completed Day 90 survey to date. Of 14 patients in the CT cohort, 8 completed Day 30 and 2 of 8 completed Day 90 survey to date. Conclusions: In this underserved population, we report that over 50% of patients experience moderate to severe financial toxicity with over 20% having significant difficulty paying for necessities of daily living. As more follow-up data with Day 30 and 90 surveys is collected, more information about the dynamics of financial toxicity will be available to identify areas of cancer care improvement.