ASH 2024 | A study investigating disparities in QoL and financial toxicity in patients with MDS

Myelodysplastic syndrome, or neoplasm, is a disease primarily of non-Hispanic white male population. So not a lot is known about sex and race disparities in MDS. Health-related quality of life can be impacted by both disease-related symptoms and also treatment-related adverse events. And it is actually being considered as an important clinical trial endpoint for patients with lower-risk MDS. So it’s getting more and more prominence. Financial toxicity is a term that is used to describe the burden on patients for the cost of cancer care. And it also can negatively impact the overall outcome of patients’ treatment non-adherence and quality of life. So we set out to undertake this prospective study on MDS patients where we did two surveys four months apart. We measured health-related quality of life by the quality of life in myelodysplasia scale or QUALMS scale, which gives you a value from zero to 100 and lets you know how the quality of life of patients is. And then we measured the financial toxicity or financial burden by cost questionnaire. What we found is firstly about the sex differences. The female patients in our study had a higher incidence of therapy-related MDS. They also were relatively younger compared to male patients. Male patients, on the other hand, were more likely to be RBC transfusion-dependent at baseline, and also they had a higher incidence of RUNX1 mutations. We did not find any sex-related differences in leukemia-free and overall survival for these patients. Coming to the race ethnicity standpoint, patients with Hispanic ethnicity had a higher rate of leukemic transformation, which possibly points towards ethnic differences in disease biology in this patient population. We also found that patients of other race ethnicity than non-Hispanic whites had worse physical burden in terms of quality of life and financial burden for patients, particularly those of African-American race had worse financial burden as well. There are also patients of other race ethnicity who were also younger compared to the non-Hispanic white male population. When we looked at the difference based on the disease factors, anemia hemoglobin less than 10 and RBC transfusion dependence were associated with a significantly lower quality of life in patients, and this was also true; these two factors came to be important when we were measuring financial toxicity as well, and patients who were having low quality of life at baseline were more likely to get transfused and hospitalized before the next survey time point as well. Lastly, regarding treatment-related factors, any treatment led to a worse physical burden on patients as far as quality of life and considered compared to patients on observation. And particularly, HMA-based therapy, which is used in some of our higher-risk patients, were associated with also worse financial burden on the patient population. So overall, our study provided highlights and sex and race disparities and importance of disease and treatment-related factors on quality of life and financial toxicity in MDS, which is I think very important as we explore newly approved high-cost medications use and widespread use of those in this patient population.

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