Financial burden common among adults with graft-versus-host disease
SALT LAKE CITY — Financial and employment hardships appeared common among adults with graft-versus-host disease following hematopoietic stem cell transplant, according to study results presented at the BMT Tandem Meetings.
Tailored resources, such as structured rehabilitation and assistance programs, are needed to assist with financial and work-related complications following HSCT, the research showed.
“Chronic graft-versus-host disease is a major complication that contributes to the long-term morbidity and mortality of the procedure,” Nandita Khera, MD, MPH, hematologist at Mayo Clinic in Scottsdale, Arizona, said during her presentation. “It is likely these patients may suffer from higher financial burden because of the need for intense medical follow-up and treatments, as well as impaired functional status preventing return to work.”
Khera and colleagues administered a cross-sectional questionnaire regarding financial concerns, income, employment and insurance to patients enrolled in the chronic GVHD Consortium — a multicenter observational study that seeks to develop and validate endpoint measures for chronic GVHD treatment — to determine factors associated with patient financial burden, as well as their ability to work and go to school.
“We decided to use the rich clinical and patient-reported outcomes information collected as part of this consortium to describe the employment, insurance and financial burden information of patients,” Khera said.
Researchers evaluated responses from 190 patients (median age, 57 years; range, 12-79; 87% white).
Financial burden was defined as difficulty paying medical bills, limited money at the end of each month, reduced spending on home, using retirement savings, borrowing money, selling assets or bankruptcy.
Researchers used multivariable logistic regression models to measure sociodemographic, chronic GVHD severity, physical and mental functioning, and activity level factors.
The median time from HSCT to chronic GVHD onset was 7.5 months. Enrollment to financial survey was 12.9 months.
Median scores closest to survey completion (median, 21 days) were 40 (range 9-58) for the physical component and 50 (range 9-70) for the mental component.
The proportion of patients who reported an annual income less than $25,000 increased from 10% at enrollment to 20% at the time of questionnaire.
Researchers observed no significant change in the proportion of patients who reported working or going to school from enrollment to the questionnaire (33 vs. 38%).
Most patients had private insurance (49%) or Medicaid/Medicare (43%). One patient was uninsured. Of insured patients, 34% reported delayed or denied insurance coverage for chronic GVHD treatments.
“Out-of-pocket expenditures remain high for this population, even a long time after HSCT,” Khera said.
Sixty-six percent of patients reported experiencing financial burden. Of these, 45% attributed financial burden to their or their caregiver’s inability to go back to work, or a lower salary.
Regression analyses indicated factors associated with ability to work or go to school included a minimum income of $75,000 (OR = 12.2; P = .01), younger age (OR = 0.94; P = .001), and higher physical component summary score (OR = 1.12; P = .002) and mental component summary score (OR= 1.06; P = .009).
When adjusting for all other factors, an income of $75,000 or higher appeared associated with lower financial burden (OR = 0.12; P = .025).
“Providers need to be aware of the ‘financial toxicity’ of allogeneic HSCT [and] recognize vulnerable patients at risk for catastrophic economic outcomes for self and their family,” Khera said. “Advocacy efforts and policy changes [are] needed to ensure optimum long-term coverage for HSCT patients.” – by Melinda Stevens
Khera N, et al. Abstract 14. Presented at: BMT Tandem Meetings; Feb. 21-25, 2018; Salt Lake City.
Disclosures: HemOnc Today could not confirm the authors’ relevant financial disclosures at the time of reporting.