Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma

Abstract

Background: Patients with multiple myeloma (MM) may be on therapy for years, which can lead to financial toxicity (FinTox) or time toxicity (TimeTox). The prevalence, predictors, and quality of life (QOL) impacts of FinTox and TimeTox during different phases of MM treatment have not been characterized.

Patients and methods: We conducted a single-center cross-sectional survey of patients with MM who had undergone transplantation. FinTox+ was defined as a COST-FACIT score <23, TimeTox+ as MM-related interactions (including phone calls) ≥1x weekly or ≥1x monthly in-person among far-residing patients, QOL using PROMIS Global Health, and functional status using patient-reported Karnofsky performance status (KPS).

Results: Of 252 patients, 22% and 40% met FinTox+ and TimeTox+ criteria respectively. Respective FinTox+ and TimeTox+ proportions were 22%/37% for patients on maintenance, 22%/82% with active therapy, and 20%/14% with observation. FinTox+ predictors included annual income (P < .01) and out-of-pocket costs (P < .01). TimeTox+ predictors included disease status (P < .001), caregiver status (P = .01), far-residing status (P < .001), and out-of-pocket costs (P = .03). FinTox+ was associated with a clinically meaningful decrease in mental QOL, while TimeTox+ patients were more likely to have KPS ≤ 80.

Conclusions: In our large study, monetary status but not disease status predicted FinTox. Over a third of patients on maintenance reported TimeTox. FinTox+ was associated with decreased mental health, while TimeTox+ was associated with worse performance status. These two toxicities may negatively impact patient wellbeing, and studies of strategies to mitigate their impact are in development.

Keywords: Financial toxicity; Multiple myeloma; Quality of life; Supportive care; Time toxicity.

Figure 1:. MM-related interactions and disease status

Distributions of responses to questions about typical frequencies of MM-related visits or phone calls, as stratified by disease status: (A) patients on frontline maintenance, (B) patients on active therapy for relapsed MM, and (C) patients on observation. Note that our definition of time toxicity also included far-residing patients with in-person visits occurring at least monthly (not detailed in this figure). Abbreviations: MM, multiple myeloma; ≤1x/mo, less than or equal to one time per month; 1–2x/mo, 1–2 times per month; ~1x/wk, approximately 1 time per week; >1x/wk, more than one time per week.

Figure 2:. Financial toxicity, household income, and out-of-pocket costs

Box plots of COST scores (lower scores indicate worse financial toxicity) are shown based on patient-reported annual household income and monthly out-of-pocket costs, both in United States Dollars. The red line (COST score 23) represents the 25^th percentile of COST scores across all respondents; scores below this threshold were considered to be FinTox+. Solid dots represent outliers (here, beyond 150% of the interquartile range below the first quartile).