Financial toxicity after bone marrow transplant (BMT): A longitudinal, prospective study of quality of life and outcomes.

310 Background: Financial toxicity is prevalent among BMT patients and linked to reduced quality of life (QOL), but prior studies have relied on single time points. The evolution of post-BMT financial toxicity and its association with quality of life is unknown. Methods: This prospective cohort study included fully insured patients undergoing BMT from 01/2018-03/2023 at a large academic medical center. Surveys capturing financial toxicity and QOL were administered at new patient evaluation (NPE), and at 90, 180, and 365 days post-transplant. Financial toxicity was assessed using the Comprehensive score for Financial Toxicity (COST; none scores [ > 26), mild [14-25), moderate-high [1-13]). QOL was measured using the Functional Assessment of Cancer Therapy – BMT (scored 0-100, higher scores indicate better QOL). Longitudinal trends in financial toxicity and QOL were analyzed using mixed models with random intercepts, based on time-varying financial toxicity levels. Relative risks (RR) and 95% confidence intervals (CI) of financial toxicity were estimated using generalized linear mixed-effects models with random effects for subjects. Multivariable adjusted, time-varying Cox models estimated hazard of financial toxicity on post-BMT mortality via hazard ratios (HR) and 95% CIs. Results: Of 214 transplanted patients alive a year after BMT (median 58y (IQR 46-66), 62% male, 80% white, 51% college educated), 47% had leukemia, 27% myelodysplastic syndrome, and 9% lymphoma. At NPE, 56% of patients reported no, 26% mild, and 18% moderate-high financial toxicity. Patients with financial toxicity reported more cost-cutting behaviors, including reduced spending on food or clothing, using their savings, or not filling a prescription because of costs (p < 0.001 for all). Expected probability of any financial toxicity reduced over time (44% NPE, 39% D90, 33% D180, 29% D365). Patients > 65y and income > $90,000 at transplant had 64% and 67% decreased risk of financial toxicity, respectively, compared to counterparts (RR 0.36 [0.20-0.65]; RR 0.33 [0.19-0.59]). QOL in patients (n = 119) with no/mild financial toxicity improved post-transplant, but significantly worsened for those with moderate-high financial toxicity over 1 year (Table). Adjusted for age, income, and education, financial toxicity was not significantly associated with premature death post-transplant (n = 214, HR 1.14 [0.63, 2.07]). Conclusions: Financial toxicity remains prevalent after BMT and follows distinct trajectories by baseline risk. Patients with persistent or worsening financial hardship experience declining quality of life over time. Interventions to monitor and address financial strain are needed throughout the transplant continuum. Mean financial toxicity (FT) and QOL post-transplant. QOL Scores No FT Mild FT Moderate-High FT COST Slope NPE 88 82 79 0.37 D90 91 83 79 0.56 D180 89 89 72 0.60 D365 92 89 70 0.73