title: Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study.
abstract: BACKGROUND
  Financial toxicity is increasingly recognised as adversely affecting the quality of life and medication adherence in patients with cancer in the USA. Patients with multiple myeloma might be particularly vulnerable because of high use of novel treatments and extended treatment duration.
  
  
  METHODS
  Between Aug 18, 2014, and Jan 7, 2015, we did a cross-sectional survey of individuals receiving at least 3 months of ongoing treatment for multiple myeloma at a tertiary academic medical centre in the USA. The survey was derived from previous reported studies and included the 11-item COST measure (financial toxicity score range 0-44). A paper survey was offered to eligible patients on arrival for routine follow-up visits, and participants were asked to complete the survey before or after their visit to the clinic. Insurance and treatment data were obtained from patients' electronic health records.
  
  
  RESULTS
  Of 111 patients approached for the study, 100 individuals completed the survey. 59 (59%) of 100 patients reported that treatment costs were higher than expected, 70 (71%) of 99 had at least minor financial burden, and 36 (36%) of 100 reported applying for financial assistance. Use of savings to pay for myeloma treatment was common (43 [46%] of 94 patients) and 21 (21%) of 98 individuals borrowed money to pay for medications. COST scores were highly correlated with patient-reported use of strategies to cope with myeloma treatment expenses. On multivariable analysis, younger age (correlation coefficient β 0·36, 95% CI 0·15 to 0·56, p=0·00092), non-married status (5·6, 1·5 to 9·6, p=0·0074), longer duration since diagnosis (-4·8, -9·3 to -0·2, p=0·042), and lower household income (US$40 000-79 999: 7·8, 2·7 to 12·9, p=0·0031; ≥$80 000: 11·8, 7·1 to 16·4, p<0·0001) were associated with higher financial burden as measured with the COST score.
  
  
  CONCLUSIONS
  Patient-reported financial toxicity and use of coping mechanisms were common in our insured population with multiple myeloma. Additional attention to rising treatment costs and cost sharing is needed to address the increasing evidence of financial toxicity affecting patients with cancer.
  
  
  BACKGROUND
  University of Pennsylvania Perelman School of Medicine.
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: scott.huntington@yale.edu.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Huntington
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Weiss
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Cohen
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Alfred L
authors.initials: AL
authors.lastname: Garfall
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Mangan
authors.affiliation: Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.affiliation: Division of Hematology-Oncology, Division of Internal Medicine and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics*; D010865:Pilot Projects; D011788:Quality of Life; D014481:United States