title: Financial Hardship and Patient-Reported Outcomes after Hematopoietic Cell Transplantation.
abstract: Although hematopoietic cell transplantation (HCT) is the only curative therapy for many advanced hematologic cancers, little is known about the financial hardship experienced by HCT patients nor the association of hardship with patient-reported outcomes. We mailed a 43-item survey to adult patients approximately 180 days after their first autologous or allogeneic HCT at 3 high-volume centers. We assessed decreases in household income; difficulty with HCT-related costs, such as need to relocate or travel; and 2 types of hardship: hardship_1 (reporting 1 or 2 of the following: dissatisfaction with present finances, difficulty meeting monthly bill payments, or not having enough money at the end of the month) and "hardship_2" (reporting all 3). Patient-reported stress was measured with the Perceived Stress Scale-4, and 7-point scales were provided for perceptions of overall quality of life (QOL) and health. In total, 325 of 499 surveys (65.1%) were received. The median days since HCT was 173; 47% underwent an allogeneic HCT, 60% were male, 51% were > 60 years old, and 92% were white. Overall, 46% reported income decline after HCT, 56% reported hardship_1, and 15% reported hardship_2. In multivariable models controlling for income, those reporting difficulty paying for HCT-related costs were more likely to report financial hardship (odds ratio, 6.9; 95% confidence interval, 3.8 to 12.3). Hardship_1 was associated with QOL below the median (odds ratio, 2.9; 95% confidence interval, 1.7 to 4.9), health status below the median (odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6), and stress above the median (odds ratio, 2.1; 95% confidence interval, 1.3 to 3.5). In this sizable cohort of HCT patients, financial hardship was prevalent and associated with worse QOL and higher levels of perceived stress. Interventions to address patient financial hardship-especially those that ameliorate HCT-specific costs-are likely to improve patient-reported outcomes.
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: gregory_abel@dfci.harvard.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: Department of Economics, University of Massachusetts Boston, Boston, Massachusetts.
authors.forename: Randy
authors.initials: R
authors.lastname: Albelda
authors.affiliation: Department of Oncology/Hematology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Division of Blood and Marrow Transplant, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Public Policy, University of Massachusetts, Boston, Massachusetts.
authors.forename: Diana Y
authors.initials: DY
authors.lastname: Salas Coronado
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Oreofe O
authors.initials: OO
authors.lastname: Odejide
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Kira
authors.initials: K
authors.lastname: Bona
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Reginald
authors.initials: R
authors.lastname: Tucker-Seeley
authors.affiliation: Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Soiffer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006304:Health Status; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000523:psychology; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Financial hardship; Health-related quality of life; Perceived stress; Stem cell transplantation