Lack of Financial Awareness Associated with Worsened PROs After Hematopoietic Cell Transplantation

12/12/17

More than one-fifth of patients undergoing hematopoietic cell transplantation (HCT) reported a lack of awareness of financial burden prior to the procedure, according to research presented at the 59th American Society of Hematology Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).

A pretreatment awareness of HCT costs may lead to a lessening of patient-reported outcomes (PROs) posttransplant, results also showed.

Prior research has linked financial concerns with compromised reporting of PROs among patients in treatment for cancer. Gregory Abel, MD, Dana-Farber Cancer Institute (Boston, MA), and colleagues sought to determine whether patients undergoing HCT who were unaware of the financial burden reported outcomes differently than financially aware patients.

Dr Abel and colleagues mailed surveys to patients who underwent HCT at Dana-Farber Cancer Institute, Roswell Park Cancer Institute (Buffalo, NY), and Mayo Clinic (Phoenix, AZ). A total of 325 patients responded, representing a response rate of 65.1%.

Factors assessed by the study included pretreatment awareness of costs, decreases in household income following HCT, and financial hardship following HCT. Financial hardship was defined as any of the following: dissatisfaction with personal finances, an inability to make monthly bill payments, and not having enough money at the end of the month.

A total of 21.6% of patients reported a lack of awareness regarding HCT costs. The researchers did not observe significant differences in race, age, education level, or income level between aware and unaware patients.

Among aware patients, 40.6% reported being counseling from a social worker, and 23.4% reported physician counseling prior to HCT. Aware patients did not experience an association between decreases in income and worsening quality of life (QOL; adjusted odds ratio [AOR], 1.4; 0.8-2.5); unaware patients did experience worsening QOL (AOR, 4.3; 1.1-16.7; P = .04).

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Both aware and unaware patients significantly self-reported worsened QOL due to financial hardship posttransplant. However, reporting patients were greater in unaware patients (AOR, 4.7; P = .03) than aware patients (AOR, 2.7; P < .001).

 “Similar increases were observed among the unaware for the association of decline in income and financial hardship with increased perceived stress,” researchers concluded.—Cameron Kelsall