Financial Difficulty in Patients With Blood Cancer

UNC Lineberger Comprehensive Cancer Center218 enrolled

Overview

This is a hypothesis-driven, observational, cross-sectional, multi-site study of the financial difficulties experienced by patients undergoing treatment for multiple myeloma (MM) and chronic lymphocytic leukemia (CLL). It is composed of a patient survey (n=250) (Appendix A), a physician survey (n=100) (Appendix B), and a practice survey completed by each site enrolling patients onto this study (Appendix C). A subset of enrolled patients (n=35) will be invited to participate in an optional second telephone interview (Appendix D). This study will measure the prevalence of patient-reported financial difficulty, specific financial burdens and resources currently available to patients and from practices to assist with patient financial navigation.

The primary and secondary objectives of the study: PRIMARY OBJECTIVES: To estimate the proportion of individuals with MM and/or CLL who report experiencing financial difficulty in the past 12 months. SECONDARY OBJECTIVES: Our seventeen secondary objectives address ten aspects of patient financial experience of cancer treatment: Financial difficulty 2.2.1 To describe the association of patient report of financial difficulty with patient reported racial identity. 2.2.2 To describe the association of patient report of financial difficulty with insurance status. Financial navigation 2.2.3 To describe the association of patient report of financial difficulty with receiving treatment at practices that report offering patients financial guidance through navigators or social workers, and with socioeconomic status. 2.2.4 To describe the current resources dedicated to patient financial navigation at participating sites, and types of psychosocial, transportation and financial navigation interventions sites are developing. Financial burden 2.2.5 To identify distinct patterns of financial burden among patients undergoing treatment for MM and/ or CLL. 2.2.6 To examine the relationship between distinct patterns of financial burden with patient report of financial difficulty, and with patient sociodemographic, disease and treatment characteristics. Financial support 2.2.7 To estimate the proportion of patients with MM and/or CLL undergoing treatment who report receiving financial support in the past 12 months. 2.2.8 To describe the association of patient report of receiving financial support with receiving treatment at practices offering patients financial guidance through navigators or social workers, and with socioeconomic status. Patient concerns regarding treatment and costs of care 2.2.9 To describe the magnitude of patient concerns regarding treatment and costs of care. 2.2.10 To describe the association of patient concerns regarding treatment and costs of care with patient sociodemographic, disease and treatment characteristics, and practice characteristics. Patient health and well-being 2.2.11 To describe the association of financial difficulty with patient self-reported health and well-being. Physician discussion of financial difficulties with patients 2.2.12 To estimate the proportion of individuals with MM and CLL who have received treatment in the past 12 months and report to their physician experiencing financial difficulties related to their cancer care. 2.2.13 To identify the types of financial difficulties related to cancer care that patients discuss with their provider and care team. Physician attitudes regarding patient communication about financial difficulties 2.2.14 To describe physician attitudes or preferences for how they or the care team discuss financial difficulties with patients. Physician use of resources for addressing financial difficulties 2.2.15 To describe the resources used by physicians and their care team to help address patient reported financial difficulties related to cancer care. Physician perspective on the impact of COVID-19 on patient financial difficulties 2.2.16 To assess COVID-19 related disruptions to physicians' practice with respect to addressing financial difficulties in patients. Patient experience of financial difficulties 2.2.17 To conduct semi-structured qualitative interviews with a subset of patients to elucidate the patient experience of financial difficulties over time and its impact on cancer care, and structural barriers to accessing care and/or financial assistance.

Outcomes

Primary Outcomes

To estimate the proportion of patients with MM and/or CLL who report experiencing financial difficulty in the past 12 months.

Financial difficulties will be assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) financial difficulty item #28 regarding financial difficulties with a modified recall period: "Has your physical condition or medical treatment caused you financial difficulties in the past year?", measured as "Not at all/A little/Quite a bit/Very much." Participant responses will be dichotomized as follows: "Not at all" or "A little" classified as "No", and "Quite a bit" and "very much" classified as "Yes." This dichotomized response will be assessed using Wilson score confidence interval (95%).