Insurance, Financial Strain, Family Function, and Psychosocial Wellbeing in Pediatric Patients and Parents with Hematologic Malignancies

• Published in: Blood 2024-11, Vol.144, p.2279-2279
• Main Authors: Syed, Nadia, Dusetzina, Stacie, Koyama, Tatsuki, Schremp, Emma, Smalls, Meredith, Friedman, Debra L.
• Format: Article
• Language: English
• ISSN: 0006-4971
• DOI: 10.1182/blood-2024-207908

Objective: Survival rates for pediatric cancerhave increased due to therapeutic advances. However, many newer treatments are costly, and may be associated with financial toxicity, family dysfunction, and psychosocial impairment. This study examines these outcomes in a cohort of patients treated for hematologic malignancies. Study Design: This is a cohort study with English and Spanish speaking patients 21 years or younger, diagnosed with a hematologic malignancy from 2017 - present in the pediatric oncology program at Vanderbilt University Medical Center. Baseline surveys include the COST-FACIT measuring financial toxicity, General Functioning-6 (GF6) measuring family function, PROMIS-57 Adult and PROMIS-49 Parent/Pediatric in part measuring anxiety and depression, and PedsQL measuring health-related quality of life. Analyses were conducted using Wilcoxon rank sum test and Fisher's test for continuous and categorical data, respectively. Correlation between two continuous variables is estimated and reported with 95% confidence intervals. Results: Of the 99 participants enrolled to date, the median (quartiles) age is 8.0 (5.0, 15.8) years, with 51% male, 78% White, 10% African American, and 4% Hispanic. 80% of participants have a diagnosis of leukemia and 20% of lymphoma. There are 65% of participants on active therapy and 45% have enrolled on a clinical trial. More than half (55%) of the participants' designated primary parent have an educational background of high school or less, with 66% parents married, 26% single, and 8% divorced or separated. Most (63%) participants have private insurance, 32% have public insurance, 3% are uninsured and 2% have unspecified coverage. On the COST-FACIT survey, among 95 participants, the median score was 23.0 (17.0, 30.0), where lower scores are associated with greater financial toxicity. Approximately 17% of participants reported Grade 2 (high level) financial toxicity (score 1-13), 45% experienced Grade 1 financial toxicity (score 14-25), and 38% reported no financial toxicity (score >25). Those with public insurance reported significantly worse financial toxicity compared to those with private insurance (median COST-FACIT score of 20 versus 25; p=