Financial Toxicity, Psychological Well-Being, and Quality of Life in Hematopoietic Stem Cell Transplantation

Abstract

Background: Financial toxicity is a well-documented consequence of cancer care and may disproportionately impact patients with hematologic malignancies due to the high cost and intensity of hematopoietic stem cell transplant (HSCT). This population is particularly vulnerable to the psychological consequences of financial toxicity; however, the longitudinal relationship between financial toxicity and psychological well-being-particularly positive psychological well-being-remains understudied.

Objective: To assess longitudinal associations between financial toxicity and patient-reported psychological distress (anxiety, depression, and post-traumatic stress disorder [PTSD] symptoms), positive psychological well-being (PPWB), coping, and quality of life (QOL) in patients with hematologic malignancies who received allogeneic HSCT.

Study design: We conducted a secondary analysis of prospective longitudinal data from 150 adult allogeneic HSCT recipients to examine the associations between financial toxicity and patient-reported psychological distress, PPWB, coping, and QOL in allogeneic HSCT survivors. Financial toxicity was measured using the Comprehensive Score for Financial Toxicity. Patient-reported psychological distress was assessed with the Hospital Anxiety and Depression Scale and the PTSD Checklist. PPWB was measured using the Revised Life Orientation Test, Positive and Negative Affect Scale, Flourishing Scale, and Satisfaction with Life Scale. Coping was assessed using the Brief-COPE, and QOL with the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation. We fitted a mixed-effects model for each outcome, adjusting for age, employment status, income, type of transplant, and transplant setting.

Results: Among 150 participants (58.7% men; 94.6% non-Hispanic/Latino; 92.0% White; mean age 57.5 years [SD 13.5]), adjusted mixed-effects models indicated that lower financial toxicity was associated with lower anxiety (β = -0.104; P < .001), lower depression (β = -0.117; P < .001), and fewer PTSD symptoms (β = -0.280; P < .001). Lower financial toxicity was also associated with higher optimism (β = 0.112; P < .001), positive affect (β = 0.197; P < .001), flourishing (β = 0.201; P < .001), and life satisfaction (β = 0.181; P < .001), as well as lower avoidant coping (β = -0.043; P < .001) and improved quality of life (β = 0.596; P < .001).

Conclusion: Lower financial toxicity was significantly associated with improved psychological distress (anxiety, depression, and PTSD symptoms), positive psychological well-being (optimism, positive affect, flourishing, and satisfaction with life), avoidant coping, and QOL in allogeneic HSCT survivors. These findings suggest that supportive interventions targeting financial toxicity in the HSCT population have the potential to impact psychological well-being, coping, and QOL, warranting further study.