The Dynamics of Financial Toxicity in Multiple Myeloma

Abstract People with multiple myeloma may be more susceptible to financial toxicity and its sequelae than other cancer types due to the high cost of treatment and its onset occurring typically late in life. However, little data exist regarding financial toxicity among people with myeloma. In this study, a cohort of 135 patients were recruited from an ongoing observational trial to complete the Comprehensive Score for financial Toxicity (COST). Participants were sent follow-up surveys at 3, 6, and 12 months. The median age was 68 years; the majority were Caucasian (88%), male (63%), held a college degree (61%), and had left the workforce (70%). The median time from myeloma diagnosis was 28 months. The median COST score was 27; 48% of participants had a score below 27 and considered to have higher levels of financial toxicity. The only characteristic associated with financial toxicity was a college degree. After controlling for other covariates, those with a college education were 69% less likely to have higher financial toxicity. Of the 108 participants who completed a follow-up survey, 34% had their financial toxicity status reclassified at a subsequent time point. Reclassification from lower to higher financial toxicity was more common than the reverse. Because financial toxicity is a dynamic process, which patients are experiencing it at any given time is difficult to predict. Moving the research agenda from prediction to improved detection and intervention is likely warranted.