Financial toxicity and quality of life among people with chronic myeloid leukemia on tyrosine kinase inhibitors.
Authors: Burns Emily J , Paul Sudeshna , Lee Stephanie , Jin Ruiqi , Henry Rema , Jennings Bonnie Mowinski , Waldrop Drenna , Hunter Anthony , Bruner Deborah Watkins , Yeager Katherine 
Published: June 2023

e18918

Background: Costs associated with treatment of Chronic Myeloid Leukemia (CML), along with out of pocket (OOP) expenses related to cancer care, put CML patients at risk for financial toxicity (FT). Although FT is considered a side effect of many cancer treatments, little is known about how FT affects quality of life among CML patients treated with Tyrosine Kinase Inhibitors (TKIs). In this study, we examined the association between FT, demographic factors, and health related quality of life (HRQOL). Methods: A secondary analysis was conducted using data from a parent study examining adherence trajectories in people with CML treated with TKIs. Descriptive, bivariate, and multivariate analyses were used to describe the sample, assess demographic and disease-specific FT correlates, and assess the predictive value of FT on HRQOL. FT was assessed by the Comprehensive Score for Financial Toxicity (COST Facit V2; higher scores were better) along with the Medical Expenditure Panel Survey (MEPS). HRQOL was assessed using the EuroQol 5-Dimension (EQ-5D-5L) single summary index score. Results: Of the 118 participant sample, about half were male (52%), White (57%), married (53%), and currently employed (59%) with a mean age of 49. Most had some college credit (76%). Many reported making financial sacrifices because of cancer costs (42% reduced spending on vacation/leisure activities, 31% delayed large purchases, 24% reduced spending on basics like food and clothing, and 27% used savings set aside for other purposes). Most (62%) reported ever being worried about having to pay large medical bills related to their cancer and 15% reported borrowing money or going into debt to cover cancer care costs. About half (51%) reported never discussing OOP costs for cancer care with their doctor. Overall, participants reported low FT (mean = 25, standard deviation = 11), but approximately 26% of respondents noted FT levels associated with significant financial burden (COST < 17.5). In bivariate analyses, greater FT was associated with Black race, not married/partnered status, unemployed, high school education or less, and lower income. FT was not significantly associated with gender or age. In multivariable models, FT was significantly associated with HRQOL index (β = 0.011, SE = 0.002, P < 0.001) after adjusting for individual characteristics. Age (β = -.003, SE = 0.001, P = 0.01) and education (β = .125, SE = 0.05, P = 0.027) also seemed to be important correlates of HRQOL index. Conclusions: Financial concerns are a common worry for individuals receiving treatment for CML. The association between FT and HRQOL suggests a need for assessing and addressing FT as part of routine care of people with CML who are taking TKIs. Further work is needed to understand the longitudinal experience of FT of people with CML on continuous treatment to help identify individuals who are most in need of intervention across the treatment continuum.