The following is a summary of “Association between financial fragility and treatment patterns in multiple myeloma.,” published in the 2024 ASCO Annual Meeting under the issue of Oncology by Su et al.
High out-of-pocket costs for Multiple Myeloma (MM) drugs raise concerns about treatment access for patients with financial fragility (FF).
Researchers conducted a retrospective study in Washington State using a unique database linking patient credit records to cancer data to explore how FF impacts MM treatment.
They scrutinized newly diagnosed patients with MM (2012-2020) with Medicare and commercial health insurance, using a database linking WA cancer registry data, health insurance claims, and depersonalized credit reports (TransUnion). Patients received combination therapy within 6 months of diagnosis. The FF was identified by credit report indicators like charge-offs in 50 days before and after, collections, liens, etc. Suboptimal treatment included delays (>40 days from diagnosis), treatment interruptions (gap of >30 days without treatment in the first 6 months), or lack of autologous stem cell transplantation (ASCT) within 12 months. Chi-squared tests and multivariable logistic regressions were performed, adjusting for age, sex, race (white/nonwhite), insurance type, and Area Deprivation Index (dichotomized; 1-5 and 6-10).
The results showed 204 eligible patients (median age 69 years, 60% male, 91% White, and 60% Medicare-insured), 39 patients (19%) had evidence of FF, and 120 patients (59%) met the composite outcome. The FF was significantly associated with the composite outcome of suboptimal treatment in bivariate analysis (74% vs. 55%, P=0.03) and adjusted multivariable analysis (OR 2.41 [95% CI: 1.05-5.51], P=0.04). In this cohort, 182 (89%) patients received ASCT within 12 months. A sensitivity analysis removing ASCT as a component outcome revealed that 108 patients (53%) met the composite outcome. The FF was associated with the composite outcome of suboptimal treatment in bivariate analysis (69% vs. 49%, P=0.02) and adjusted multivariable analysis (OR 2.31 [95% CI: 1.05-5.10], P=0.04).
Investigators found FF to be associated with poorer MM treatment, including delays, interruptions, and receiving fewer stem cell transplants.
Source: meetings.asco.org/abstracts-presentations/233266
