Financial toxicity, time toxicity, and quality of life in multiple myeloma

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 < 0.01) and out-of-pocket costs (p < 0.01). TimeTox+ predictors included disease status (p < 0.001), caregiver status (p = 0.01), far-residing status (p < 0.001), and out-of-pocket costs (p = 0.03). 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. MICRO-ABSTRACT In this single-center analysis of over 250 patients with multiple myeloma, financial status but not disease status predicted financial toxicity. While disease status predicted time toxicity as expected, over a third of patients with myeloma on maintenance alone reported time toxicity. Financial toxicity was associated with a meaningful decrease in mental quality of life.