Session: 905. Outcomes Research – Lymphoid Malignancies: Poster I
Hematology Disease Topics & Pathways:
adult, Clinical Practice (Health Services and Quality), Plasma Cell Disorders, Diseases, Lymphoid Malignancies, Human, Study Population
Methods: We surveyed (by mail and online) English-speaking MM patients who had undergone auto-transplantation at our US institution. Survey questions included financial stressors (COST inventory), frequency/convenience of in-person vs telehealth visits, and physical/mental QOL [PROMIS Global Health, with minimum clinically important difference (MCID) 5].
FinTox+ was defined as COST score <23 (25th percentile). After discussions with local patients, we defined TimeTox+ as either (a) MM-related interactions (including in-person visits, telehealth / telephone calls, infusions, and labwork) ≥1x per week on average and/or (b) in-person MM-related interactions ≥1x per month in far-residing patients (defined as patients who reported that interactions with their primary MM provider usually required ≥4 hours away from home). Variables were compared descriptively using Fisher’s and rank-sum test. Predictors of FinTox and TimeTox were identified using adjusted multivariable logistic regression.
Results: Of 670 patients, 252 (38%) completed the survey as described in Table 1. 64% were on maintenance, 21% on observation, and 16% on active treatment for relapsed MM. Far-residing patients comprised 20% of respondents.
Among n=207 (82%) who completed the COST inventory, the median COST score was 31 (IQR 23-37). Of these respondents, 22% (n=45) were FinTox+. Most (59%) reported monthly MM-related out-of-pocket costs <$100, but 15% reported MM-related expenses ≥$500 monthly. While physical QOL scores were comparable between FinTox+ and FinTox- respondents, FinTox+ respondents had significantly worsened mental QOL (median PROMIS scores 45.8 vs 50.8, p <0.01).
Time toxicity was reported by 40% (n=101) overall, including 14% of 51 respondents on observation, 37% of 155 respondents on maintenance, and 82% of 38 respondents with relapse. Unsurprisingly, TimeTox was more prevalent among far-residing respondents (73% vs 31%, p<0.001). Far-residing respondents were less likely to rate in-person visits as convenient (Figure 1A, p<0.001), with 62% (far-residing) vs 89% (near-residing) agreeing that in-person visits were easy to attend. However, near-residing and far-residing respondents had similar frequencies of in-person visits (Figure 1B, p=0.37). Telehealth visits were rated similarly conveniently by both far-residing and near-residing respondents (Figure 1C, p=0.77). Telehealth visits were more common in the far-residing cohort (Figure 1D, p=0.01), with 54% vs 32% of respondents reporting ≥1 telehealth visit in the past year. Median physical QOL (44.9 vs 47.7) and mental QOL (48.3 vs 50.8) were both significantly worse in TimeTox+ respondents but within the MCID.
In adjusted multivariable analyses, predictors of FinTox were younger age (OR=1.10, p<0.001) and annual income <$50K (OR=6.29, p<0.001). Predictors of TimeTox were disease status (reference: observation; relapsed OR=22.69, maintenance OR=3.21, p<0.001) and far-residing status (OR=5.72, p<0.001).
Conclusion: In our study of over 250 patients with MM, 22% reported FinTox while 40% reported TimeTox. FinTox was associated with lower income as well as a clinically meaningful decrease in mental QOL, suggesting benefit for FinTox screening and early referral to financial navigation services. TimeTox was reported by over a third of patients on maintenance, and further research into reversible drivers of TimeTox is ongoing: for example, workflows to increase local lab monitoring and decrease in-person visit frequency for patients on oral maintenance. Limitations of our study include selection bias, recall bias, and lack of generalizability to transplantation-ineligible patients. Additionally, universal definitions for FinTox and TimeTox have not yet been standardized. However, this is the largest study of these toxicities in MM to date and serves as a starting point for larger more definitive prospective research.
Disclosures: Banerjee: SparkCures: Consultancy; Sanofi: Consultancy; Genentech: Consultancy; Janssen: Consultancy; BMS: Consultancy; Caribou: Consultancy; Pfizer: Consultancy; Pack Health: Research Funding. Cowan: BMS, Adaptive: Consultancy; Adaptive Biotechnologies, Harpoon, Nektar, BMS, Janssen, Sanofi, Abbvie: Research Funding. Carpenter: Incyte, Janssen, AbbVie, and Sanofi: Research Funding. Lee: BMS: Honoraria; Fresenius Kabi: Consultancy; Kadmon: Honoraria; Sanofi: Consultancy, Honoraria; Kite Pharma: Honoraria, Speakers Bureau; Incyte Corp: Consultancy, Research Funding. Mehta: CSL Behring: Research Funding; Kadmon: Research Funding; Incyte: Research Funding. Kuderer: Astra Zeneca, Janssen, Pfizer, BMS, Beyond Springs, G1 Therapeutics, Sandoz, Seattle Genetics, Fresenius: Consultancy. Lee: Amgen, AstraZeneca, Incyte, Kadmon, Pfizer, Syndax: Research Funding; Janssen: Other: Study medication provider; Novartis: Other: Steering Committee member; Equillium, Kadmon, Mallinckrodt: Consultancy.
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