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Financial Hardship Experienced During Transplant in Myelodysplastic Syndromes With Christopher Su, MD

At the recent American Society of Hematology (ASH) Annual Meeting in San Diego, Christopher Su, MD, a Hematologist at the Fred Hutchinson Cancer Center, presented his research regarding financial hardships experienced in the transplant setting for myelodysplastic syndromes (MDS). Dr. Su then set down with Oncology Data Advisor to further discuss his study, the results, and next steps.  

Oncology Data Advisor: Today, we are here with Dr. Christopher Su. Thank you so much for your time today. Would you like to introduce yourself and your research interest?

Christopher Su, MD: Yes, no problem. It's a pleasure to be here. My name is Dr. Christopher Su. I'm a Hematologist at the Fred Hutchinson Cancer Center. My research focus is really based on patient-reported outcomes and especially the finance outcomes of patients who have blood cancers.

Oncology Data Advisor: To start off, would you like to just tell us what the BMT CTN 1102 study is?

Dr. Su: The BMT CTN 1102 study is a big multicenter trial that enrolled patients from 34 centers across the United States. The patients who were enrolled were individuals with high-risk MDS, and the overall trial sought to look at survival outcomes between those who got allogeneic stem cell transplants versus those that did not. Basically, the main trial demonstrated a survival benefit in the individuals that got transplant over those that did not get transplant.

Oncology Data Advisor: Why did your team feel it was necessary or important to include this parallel economic evaluation of the study?

Dr. Su: We know that even though transplant is used in many different settings and there's a lot of superior survival outcomes, transplant is a remarkably expensive process, not just to the health system, but also to the patients. And really, we feel that all the positive clinical outcomes need to also be balanced with equitable patient affordability as well. That's why we decided to do an analysis on the patient-level affordability of transplant.

Oncology Data Advisor: If you wouldn't mind, could you give just a brief overview of how you guys conducted the economic evaluation and your results that you found?

Dr. Su: Basically, we sent out invitations to trial participants asking them to report their out-of-pocket costs as they went through the trial. This was for both the individuals that got transplant and those that did not get transplant. We administered these surveys in three waves at one month, seven months, and 19 months after enrollment. Then the surveys asked individuals for their out-of-pocket costs in various domains such as outpatient visits, prescription medications, travel, and accommodation. We then synthesized these out-of-pocket costs to look at how it was different between the patients who got transplant and who didn't get transplant.

Oncology Data Advisor: Were there any limitations that your team experienced in the financial hardship side of this study?

Dr. Su: Obviously we found that individuals who got transplant have very high out-of-pocket costs, even within the confines of a trial. So, one of the remarkable findings is that even 19 months after enrollment, individuals who got transplant were still paying about $5,000 out-of-pocket every year, which is very significant. Also, considering that a lot of these patients with MDS are older and they're already retired, they're drawing on their retirement savings. As to the limitations that you mentioned, one of the limitations obviously is that we didn't have any receipts. All of these numbers are reported by the patients, and this was done within the context of a trial. We also don't know in the real world with just transplant patients in general, whether this is reflective of the same cost borne by patients with transplants, but we suspect it's probably pretty similar.

Oncology Data Advisor: How do you suggest we further raise awareness to combat this situation of a tremendous out out-of-pocket cost for transplant patients?

Dr. Su: I think clinicians and the patient support team at these cancer centers and transplant centers should be very transparent upfront with patients about the cost associated with transplant, because I think patients shouldn't be surprised a few months down the road after their transplant, realizing that there are all these additional expenses that they have to take care of. I think another thing is the importance of getting social workers and patient navigators involved very early on in the transplant process to discuss care ability with the patients so that even before the transplant happens, there's a lot of planning that goes in so that we're proactively approaching the problem rather than reactively trying to solve the difficulties of financial toxicity.

Oncology Data Advisor: Last question I wanted to ask you is, do you and your team have any next steps for future studies of something similar with out-of-pocket costs?

Dr. Su: Yes, so again, this study was done within the context of a big study, so a lot of the questions were preformulated, but we did learn a lot from the survey that we conducted. Going forward, it would be interesting to do a similar study among our current transplant patients to see what the care burden is—and I think, importantly, to also compare some of these outcomes across different transplant centers located in different geographic regions in the United States, because we know that there is also a lot of disparity between urban and rural populations.

So, there are definitely a lot of nuances that could be teased out, and I think finally one of the things that we're very interested in is to assess the level of support that each transplant center has when it comes to compounding financial toxicity and difficulty that the patients face. It might be interesting to see the variance that exists between transplant centers in terms of how much support they can provide patients from a financial angle.

Oncology Data Advisor: Definitely. Awesome. Well, we're so excited to hear more about your future studies and everything in your research. So thank you so much for your time today, Dr. Su.

Dr. Su: Thank you for inviting me. It's my pleasure. Thank you.

About Dr. Su

Christopher Su, MD, is an Assistant Professor in the Division of Hematology and Oncology at the University of Washington and a Hematologist at the Fred Hutchinson Cancer Center. Dr. Su's research and passion revolve around patient-reported outcomes, combatting financial hardships that disrupt access to care, and improving access to high-quality cancer care.

For More Information

Su C, Saber W, Bansal A, et al (2023). Out-of-pocket costs and financial hardship among participants of the BMT CTN 1102 study. Presented at: 2023 American Society of Hematology (ASH) Annual Meeting. Abstract 262. Available at: https://ash.confex.com/ash/2023/webprogram/Paper187218.html

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor. 


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