Conference Coverage

Financial Hardship Linked to Delayed Treatment Initiation in Hematologic Malignancies

Edited by:
Anthony Calabro, MA

Key Highlights

  • A retrospective study of 1,110 insured patients with DLBCL, MM, or CML found a 24% prevalence of adverse financial events (AFEs) at diagnosis.
  • Patients with AFEs experienced longer time to treatment initiation (48 vs 41 days) and were more likely to have treatment delays exceeding 60 days.
  • Financial hardship was associated with younger age, non-white race, Medicaid coverage, and higher socioeconomic deprivation.

A retrospective study presented at the 67th ASH Annual Meeting and Exposition in Orlando, FL, examined whether adverse financial events influence the timing of treatment initiation among insured patients diagnosed with diffuse large B-cell lymphoma (DLBCL), multiple myeloma (MM), or chronic myeloid leukemia (CML). Investigators reported that patients who experienced significant financial hardship at the time of diagnosis had a longer time to treatment initiation (TTI), raising concerns that economic stress contributes to barriers to high-quality cancer care.

Researchers conducted a retrospective analysis using the Fred Hutchinson Cancer Center Data Repository, which integrates data from the Surveillance, Epidemiology, and End Results Program, insurance claims, and TransUnion credit reports. Eligible patients were diagnosed between 2012 and 2021, received chemotherapy or targeted therapy within 1 year, and had a credit report within 50 days of diagnosis. AFEs included foreclosures, repossessions, liens, charge-offs, collections, or past-due debt. TTI was calculated from diagnosis to the first treatment claim. Multivariable linear and logistic regression models assessed the association between AFEs and TTI, adjusting for demographic and socioeconomic variables. A TTI greater than 60 days was defined as a prolonged treatment start.

Study Findings

Among the 1,110 patients identified, 531 had DLBCL, 463 had MM, and 116 had CML. The median age was 69 years; 57% were male, 88% white, and 30% lived in areas of higher socioeconomic disparity. Although all patients were insured, insurance coverage varied: 47% had Medicare, 27% had commercial coverage, 10% had Medicaid, and 15% had multiple forms of coverage.

AFEs were present in 24% of patients. Those with AFEs were more often younger (61 vs 69 years; P < .001), non-white (33% vs 23%; P = .01), diagnosed with CML (43% vs 23% DLBCL and 22% MM; P < .001), and living in areas with higher socioeconomic deprivation (40% vs 26%; P < .001). Medicaid coverage was significantly more common among patients with AFEs (59%; P < .001).

Patients with AFEs experienced delayed treatment initiation (48 vs 41 days; bivariate P = .01; multivariable P = .02). They were also more likely to have TTI exceeding 60 days (21% vs 14%; multivariable OR 1.66; 95% CI, 1.14–2.43; P = .01). Other demographic variables were not significantly associated with treatment timing.

Clinical Implications

According to the study authors, the findings indicate that financial hardship at diagnosis may impede timely cancer treatment, even in insured populations. They note that nearly one-quarter of patients had significant financial stress, underscoring the potential value of financial navigation interventions to support equitable care.

Expert Commentary

“Insured patients with hematologic malignancies with AFEs had delayed TTI, suggesting that financial hardship at diagnosis may be a barrier to high-quality care, even among patients with health insurance,” the researchers concluded.

Reference
Su C, Li L, Fedorenko C, et al. Adverse financial events and delayed treatment initiation among patients with hematologic malignancies. 67th ASH Annual Meeting and Exposition; December 6-9; Orlando, FL. Accessed December 5, 2025. https://submit.hematology.org/program/presentation/675217.