Assessing the effects of financial toxicity on quality of life among hematopoietic stem cell transplantation recipients.

Abstract

1593 Background: “Financial toxicity” refers to the financial burden imposed by treatment costs on individuals with cancer, constituting a major barrier to achieving equitable cancer outcomes. Recent literature increasingly demonstrates the detrimental impacts of financial toxicity on quality of life (QOL) among individuals with cancer, including individuals who have undergone hematopoietic stem cell transplantation (HSCT). This study evaluates associations among treatment cost burden and various aspects of QOL following HSCT. Methods: Seven hundred one HSCT recipients completed a survey examining their biopsychosocial health one year following transplant. The survey included the Functional Assessment of Cancer Therapy – Bone Marrow Transplantation (FACT-BMT), a multifactorial measure of QOL specific to this population. Treatment cost burden endorsement was measured on a 5-item Likert scale. Hierarchical regression models were developed to assess the incremental effects of demographic characteristics (i.e., Block 1), clinical predictors (Block 2), and cost burden (Block 3) on physical, emotional, social, functional, BMT-specific, general, and composite QOL outcomes. Results: Significant model improvement was observed with the addition of clinical factors ( ΔF(2,650) = 20.28, p < .001), and subsequently, treatment cost burden ( ΔF(1,649) = 110.29, p < .001). In the final model, higher cost burden was associated with poorer physical (β = -0.323, p < .001), emotional (β = -0.301, p < .001), social (β = -0.250, p < .001), functional (β = -0.317, p < .001), BMT-specific (β = -0.341, p < .001), general (β = -0.377, p < .001), and composite QOL (β = -0.381, p < .001). Poorer performance score was associated with each QOL indicator ( p < .001), with allogeneic transplant type associated with poorer functional (β = -0.001, p = .002), but higher emotional (β = 0.118, p = .002), wellbeing. Older age (β = 0.113, p = .003) and female sex predicted higher (β = 0.183, p < .001), while Hispanic ethnicity predicted poorer (β = -0.095, p = .010), social wellbeing. Female sex was associated with poorer QOL specific to BMT concerns (β = -0.118, p = .001). Conclusions: Higher treatment cost burden is associated with poorer overall QOL and its physical, emotional, social, functional, and BMT-specific components one year following HSCT, after controlling for demographic and clinical characteristics. This reflects a critical barrier to equitable cancer care, suggesting that financial toxicity may perpetuate preexisting inequities in QOL, treatment, disease, and survival outcomes that disproportionately impact the underserved. Future research should prioritize 1) better understanding relationships among complex indicators of financial toxicity, QOL, and their underpinning mechanisms and 2) developing solutions to mitigate financial toxicity of HSCT and overall cancer care.