Impact of Financial Toxicity and Time Toxicity in Myeloma QOL | Rahul Banerjee, MD, FACP | ASH 2023

Hi everyone. Thanks for listening and thanks, Halsky, for the invitation to talk about our research about time toxicity multiple myeloma. So my name is Dr. Rahul Banerjee. I'm an assistant professor of medicine at the Fred Hutchinson Cancer Center in Seattle, Washington, also at the University of Washington in Seattle. Later this week at the ASH meeting, I'll be presenting a poster about financial toxicity and time toxicity in patients with multiple Myeloma. These words sound like funny words, but they're very real concepts many of you've experienced. Financial toxicity is related to the bills, right? The economic cost per patient of having to live with myeloma. That includes direct things, for example, copays with lenalidomide, rattle, mishal, can be quite expensive. But that also includes things a little bit harder to quantify for us, but very real for you. For example, you know, have to take time off from work to come in for clinic visits or your caregiver and you have to take time off from work to be here and relocate during transplant. Time toxicity is basically a little bit even newer of a concept. The idea is that, you know, our patients, you know, they'll go through, many of you have been through everything, you know, going to transplant, so much you've been through. The question is, are all those interactions actually high yield? How necessary are they, particularly for patients in remission? How much value is being added by these, you know, phone calls and visits and so forth? And so, you know, is there some level of interactions with health care that is toxic? Meaning, not actually benefiting you, it's only causing more side effects. We still have to look into that. So we surveyed over 200 patients with multiple myeloma who had undergone transplant at our center, Fred Hutchinson Cancer Center. I'm really grateful to our patient advocates from members of the Pacific Northwest Multiple Myeloma Fighters, Northwest Myeloma Fighters, and MFighters.com. Several of them, I'll give a shout out to Chris Bebe and Connie Missimer, who actually helped design the questions with me. We were trying to capture this idea of financial toxicity, time toxicity, and what actually means to patients. One example that, for example, I feedback from patients was that, you know, I was so focused on how many times you'd be visiting clinic, how many times you're getting blood work, and they said, well, yes, that's time toxicity, but so are the phone calls. So are the phone calls to the pharmacy being an email enalidomide isn't ready yet. So are the phone calls being on revlimit, again, you know, pregnancy test arrangements, blood work, coordination, coordinating scans, stuff like that just takes time and energy out of a patient's day. And so we define time toxicity as either having to come in at least once a month for clinic visits or any visits for people who live very, very far away, or at least once per week, phone calls, visits, any interactions of any type related to myeloma. Financial toxicity, we used a survey called the cost instrument, and we said the lowest 25% of patients were having financial toxicity, meaning they would have the most burden from their treatment. Long story short, 200 plus patients who were interviewed kind of donated their time to do these surveys. We found interestingly that financial toxicity, the rates were the same, whether someone was on active therapy, lenalidomide revlimit maintenance, or observation. So interestingly to me, I would have guessed that perhaps the patients who are on active therapy had the most financial toxicity, the most issues with bills and feeling like their finances or case with a burden to them financially wasn't the case. Time toxicity was obviously very high, 80 plus percent of patients on active therapy, which makes sense if the myeloma is under remission, you need to come in a lot to get into remission. Our patients are very patient with us about this. But interestingly, 40% of patients on maintenance reported time toxicity, so frequent phone calls and so forth. Why? We are going to figure out. Many of you, I would love to hear from you why this is happening for patients on maintenance. I bet a lot of it is those phone calls that you're calling to schedule appointments, calling to schedule blood work, calling to coordinate with the pharmacy. So just know that we're working on it because that's really, you know, the whole point of maintenance therapy is for patients to feel like they can live their life to the best degree they can without the cancer being overshadowed every second of every minute of every day. It sounds like it's not quite happening. If people are spending at least once a week dealing with their myeloma by phone or in person or in clinic and visit, when the myeloma is in remission, we need to do better and we're working on it. So with that in mind, you know, I'm very grateful to the patients in particular, again, the Pacific Northwest Myeloma Fighter Support Group who helped me with this. But if any of you have ideas, we're interested because I think this is a real concept. Time toxicity would try to turn into a formally studied concept, both in terms of recognizing why it happens and more importantly, making it better for our patients. That's great. Perfect. Thank you. Thank you.