Photo Credit: Andranik Hakobyan
Oral oncolytic therapies have revolutionized the treatment of chronic lymphocytic leukemia (CLL), offering improved outcomes and convenience for patients. However, the high costs of these treatments can result in financial toxicity, which extends beyond direct out-of-pocket expenses to impact health-related quality of life and medication adherence. The relationships between financial toxicity, health-related quality of life, and adherence to oral oncolytic therapy in this population remain poorly understood. A recent study, which was presented at the 66th ASH Annual Meeting, utilized patient-reported outcomes and interviews to explore these associations in patients with CLL initiating first-line oral oncolytic therapy.
The study enrolled 47 patients with CLL starting first-line oral oncolytic therapy across two academic centers. Patients completed electronic surveys measuring financial toxicity, health-related quality of life, and medication adherence at baseline, three months, and six months. Tools included the FACIT-COST for financial toxicity, FACT-LEU for health-related quality of life, MARS-5 and PROMIS PMAS for adherence, and PROMIS PMAS for medication adherence-specific domains. Semi-structured interviews provided qualitative insights into patient experiences.
Participants had a median age of 66 years, with a majority receiving either acalabrutinib or zanubrutinib (51%) and concurrent obinutuzumab (53%). Most patients had Medicare or private insurance, with 66% reporting no copay and 57% benefiting from patient assistance programs. Despite these measures, financial toxicity was significant in 22% of patients at baseline, rising to 33% at three months and 28% at six months. Financial toxicity was worse for patients living closer to treatment centers, unemployed individuals, and Black and Hispanic patients. Interestingly, those not receiving obinutuzumab experienced worse financial toxicity at three months.
Financial toxicity was strongly correlated with lower health-related quality of life at all time points and was linked to inferior adherence to oral oncolytic therapy at baseline. Suboptimal adherence increased from 34% at baseline to 48% at six months, with nonadherence significantly associated with diminished functional and social well-being. Patients on obinutuzumab showed better adherence. Surprisingly, financial support programs, such as patient assistance programs and no copays, did not significantly mitigate financial toxicity or adherence issues.
Patients reported moderate side effect burdens, including fatigue, nausea, and diarrhea. Fatigue emerged as a critical factor, correlating with worse financial toxicity, especially among employed patients. Interviews revealed that while most patients had minimal out-of-pocket costs, many expressed anxiety about losing future financial assistance, which may exacerbate financial toxicity. Despite self-reported adherence, discrepancies between patient-reported outcomes and interviews indicated occasional missed doses.
The findings suggest that financial toxicity stems from broader concerns, such as uncertainty about long-term affordability, rather than immediate out-of-pocket costs. Fatigue also played a role in worsening financial toxicity, particularly for employed patients, underscoring the complex interplay between treatment side effects, quality of life, and economic burden.
According to the study authors, addressing financial toxicity and adherence requires tailored interventions, including better patient education, robust financial counseling, and continued evaluation of adherence assessment tools. Further research is warranted to understand how health-related quality of life and treatment-related side effects influence financial toxicity and adherence, paving the way for more effective strategies to support patients.
