Financial Toxicity and Quality of Life After Bone Marrow Transplant: A Longitudinal, Prospective Study
S. M. Qasim Hussaini, Supriya Maheshwari, Luqin Deng, Sanghee Hong, Lauren Bohannon, Dinesh Pal Mudaranthakam, Rachel Forcino, Manuel R. Espinoza-Gutarra, Andres Azuero, Courtney P. Williams, Gabrielle B. Rocque, Anthony D. SungPURPOSE
Financial toxicity is common after bone marrow transplant (BMT) and is associated with worse quality of life, but longitudinal patterns remain poorly understood.
METHODS
We conducted a prospective cohort study of insured adults undergoing allogeneic BMT (2018-2023). Financial toxicity (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) and quality of life (Functional Assessment of Cancer Therapy [FACT]–General, FACT-BMT) were assessed at baseline and at days (D) 90, 180, and 365. Longitudinal trends were analyzed using mixed-effects models. Relative risks (RR) for financial toxicity and hazard ratios (HR) for post-BMT mortality were estimated using generalized linear mixed-effects and time-varying Cox models.
RESULTS
Among 214 transplanted patients, the median age was 58 years (IQR 46-66 year), 62% were male, and 80% were White; 47% had leukemia, 27% myelodysplastic syndrome, and 9% lymphoma; and 31% died by D365. At baseline, 56% reported none/minimal, 26% mild, and 18% moderate/high financial toxicity. Financial toxicity was associated with more cost-cutting behaviors, including reduced spending on food or clothing, use of savings, and prescription nonadherence. Expected probability of ≥mild financial toxicity reduced over time (39% baseline, 34% D90, 30% D180, 26% D365). Across time points, age >65 years and income >$90,000 in US dollars (USD) had 66% and 67% decreased risk of financial toxicity, respectively, compared with counterparts (n = 148, RR, 0.34, 95% CI [0.19 to 0.59]; RR, 0.33 [0.20 to 0.57]). Quality of life (n = 119 alive and with data by D365) with none/minimal or mild financial toxicity improved after transplant compared with baseline but significantly worsened for those with moderate/high financial toxicity over 1 year. Following adjustment for covariables, financial toxicity was not significantly associated with premature death after transplant (n = 214, HR, 1.10 [0.62-1.96]).
CONCLUSION
Financial toxicity improved overtime with BMT, but persistent financial hardship was associated with quality of life. These findings support longitudinal screening and financial interventions across the transplant continuum.