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Financial toxicity and health-related quality of life in long-term survivors of acute promyelocytic leukaemia
  1. Francesco Sparano1,
  2. Maria Teresa Voso2,
  3. Adriano Venditti2,
  4. Johannes M Giesinger3,
  5. Thomas Baldi1,
  6. Massimo Breccia4,
  7. Paola Fazi1,
  8. Marco Vignetti1 and
  9. Fabio Efficace1
  1. 1Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
  2. 2Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
  3. 3University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
  4. 4Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  1. Correspondence to Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy; f.efficace{at}


Objectives We aimed to investigate the association between financial toxicity (FT) and the health-related quality of life profile of long-term survivors of acute promyelocytic leukaemia (APL) treated within a universal healthcare system.

Methods We evaluated FT using the financial difficulties item of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). We also compared the prevalence of clinically important problems and symptoms between the survivors of APL with or without FT, using evidence-based thresholds for the EORTC QLQ-C30. A multivariable logistic regression analysis was performed to explore potential risk factors associated with FT.

Results Overall, 352 long-term survivors of APL, with a median age of 53.9 years and a median time since diagnosis of 12.2 years, were analysed. Of these, 71 (20.2%) reported having FT. The prevalence of clinically important problems and symptoms was generally higher across most EORTC QLQ-C30 scales for those survivors who reported FT. The three largest differences between patients with and without FT were observed for emotional functioning (+35.4 percentage points), dyspnoea (+33.1 percentage points) and physical functioning (+27.0 percentage points). The presence of FT was independently associated with having comorbidities and not receiving a salary/pension.

Conclusions These findings suggest that even many years after being diagnosed, one-fifth of long-term survivors of APL experience FT. Interventions to assist with employment may be critical to minimise the risk of FT in the most vulnerable survivors.

  • Leukaemia
  • Quality of life
  • Survivorship

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  • Contributors Conception and design: FS and FE. Data analysis and interpretation: all authors. Writing original draft: FS and FE. Final approval of manuscript: all authors. Accountable for all aspects of the work: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AV: research funding from Jazz Pharmaceuticals; consultancy for Amgen, Servier, AstraZeneca, Pfizer, Kyte-Gilead, Abbvie, Janssen, Astellas, Astex, Otzuka, Stemline Menarini, BMS, Glycostem, Novartis and Delbert; all outside the submitted work. MV: Honoraria from Amgen, Incyte, Novartis, Dephaforum Srl, Abbvie and Astrazeneca; advisory board for Amgen; all outside the submitted work. FE: consultancy or advisory role for AbbVie, Incyte, Syros, Novartis and JAZZ Pharmaceuticals; all outside the submitted work.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.