Quality of life of chronic myeloid leukemia patients in Brazil: ability to work as a key factor

Financial Toxicity in Head and Neck Cancer Patients Treated With Proton Therapy

Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy-dimensions of "financial toxicity"-need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.

Incidence and spatial distribution of Chronic Myeloid Leukemia by regions of economic development in the state of Pernambuco, Brazil

Background

The establishment of regional development poles in the State of Pernambuco, Brazil was characterized by industrial expansion and consequent concerns about the increase in the occurrence of diseases, specifically those having long latency periods, as is the case of Chronic Myeloid Leukemia.

Methods

The study included 367 patients diagnosed with Chronic Myeloid Leukemia over a ten-year period at a reference treatment center. Records of patient charts and the TerraView software were used, respectively, for data collection and geographic mapping of the cases from the twelve established State development regions.

Results

A total incidence of 3.4 cases per 100,000 inhabitants was found, with a predominance of the disease among males, a median age of 47 years, a mestizo ethnicity, with elementary schooling and residence in urban area. Microregional incidence varied, but there was no significant variation in numbers over the years, and no relevant socio-environmental determinants were identified.

Conclusion

The present study determined the incidence and characterized the spatial distribution of Chronic Myeloid Leukemia cases over a decade in a northeastern Brazilian state. The variation in the incidence rate by region of development is compatible with a homogeneous distribution of the cases. The work is a baseline study to be used for present and future analyses of the impact of the state economic development poles and the occurrence of this chronic malignant disease.

Higher out-of-pocket expenses for tyrosine kinase-inhibitor therapy is associated with worse health-related quality-of-life in persons with chronic myeloid leukemia

PURPOSE

To explore health-related quality-of-life (HRQoL) profiles and identify socio-demographic and clinical variables associated with HRQoL in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs).

METHODS

A cross-sectional questionnaire was distributed to adults with chronic-phase CML receiving tyrosine kinase-inhibitor (TKI) therapy >3 months in complete cytogenetic response (CCyR). Respondents were anonymous. SF-36 Health Survey was used to measure HRQoL.

RESULTS

Data from 828 respondents were analyzable. 524 (63%) were male. Median age was 42 years (range 18-88 years). 648 (78%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3-178 months). 638 (77%) paid some or all of their TKI costs. Annual out-of-pocket expenses >$4600 USD was associated with lower physical component summary (PCS; -2.8 to -3.8; P = 0.0081 and 0.0009) and mental component summary (MCS; -2.1 to -4.3; P = 0.0394 and 0.0080) in multivariate analyses. Other variables significantly associated with a lower PCS and/or MCS included: (1) female sex; (2) increasing age; (3) education level < bachelor degree; (4) co-morbidity(ies); and (5) generic drug use. TKI-therapy duration 3-5 years was associated with higher PCS and MCS.

CONCLUSIONS

Higher out-of-pocket expense for TKI therapy is significantly associated with worse HRQoL in persons with chronic-phase CML in CCyR receiving TKI therapy. These data indicate the importance of drug cost and health insurance policies on people's HRQoL.

Quality of Life and Long-Term Therapy in Patients with Chronic Myeloid Leukemia

Since the development of imatinib and other tyrosine kinase inhibitors (TKIs), the prognosis for patients with chronic myeloid leukemia (CML) has markedly improved, such that most patients diagnosed with CML can now expect to live with their disease rather than die from it. However, most patients will require long-term treatment, which has deleterious effects on health-related quality of life. We review recent literature on drug-related adverse effects, long-term medication adherence, limitations to fertility and pregnancy, effects on cognitive function, ability to work, financial toxicity, pediatric populations, and treatment discontinuation. While patients with CML are fortunate to have excellent therapies available to control their disease, many are unable to lead normal lives, which challenges the notion that research is no longer needed in CML. Curing CML, i.e., no detectable disease and no need for daily medications, should remain the ultimate goal.

Variables associated with patient-reported outcomes in persons with chronic myeloid leukemia receiving tyrosine kinase-inhibitor therapy

PURPOSE

Explore patient-reported outcomes (PROs), including health-related quality of life (HRQoL), satisfaction with therapy, impact of the therapy on work and daily life, and concerns related to the therapy and identify variables associated with PROs in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs).

METHODS

Across-sectional questionnaire was distributed to adults with chronic phase CML and answered anonymously. SF-36 Health Survey was used to measure HRQoL. Our focus was on the physical component summary (PCS) and mental component summary (MCS) components.

RESULTS

Data from 819 respondents receiving TKI-therapy ≥3 months and achieving a complete cytogenetic response were analyzed. Median age was 42 years (range 18-88 years). 652 (80%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3-178 months). 629 (77%) paid some or all of their TKI costs. In multivariate analyses, female sex, increasing age, lower education level, increasing co-morbidities, concomitant medication, ≥3 symptoms, moderate or severe symptom, switch from imatinib to a second-generation TKI, and higher annual out-of-pocket expense of TKI were significantly associated with lower PCS and/or MCS. However, TKI-therapy duration 3-7 years was significantly associated with better well-being. Higher PCS or MCS score was significantly associated with higher satisfaction level with TKI-therapy and less impact of TKI-therapy on subject's daily life and work. In addition, adverse impact on daily life and work was significantly associated with more interests in TKI-therapy-related issues.

CONCLUSIONS

Social-economic and clinical variables were significantly associated with PROs in persons with CML receiving TKI-therapy.