Stuart L. Goldberg, MD, ahematology specialist at Hackensack University Medical Center,discusses financial toxicities faced in hematology.

It’s widely understood that cancer treatment is very expensive, says Goldberg. Depending on thedisease severity and type of hematologic malignancy, patients could spend over $5,000-$10,000. Moreover,a recent report from the Leukemia & Lymphoma Society indicated that, even if patients have insurance, a lymphoma diagnosis could cost over $6,000-$7,000. For patients who have short-term insurance plans, out-of-pocket costs can range anywhere from $20,000 to $40,000, Goldberg adds. Thisis problematic because it severely affects the quality of life of patients and puts them at risk of financial toxicities, Goldberg explains.

In addition to this, it is understood that patientswith cancer are twice as likely to file for bankruptcy, and when they do so, survival rates drop, says Goldberg. Although this an issue, the extent to which this impacts patients is not fully understood, according to Goldberg.

At every visit, patients should be asked several questions pertainingto how they are feeling, but they are never asked about their payment capacity, says Goldberg. Oftentimes, this question is asked when patients are first diagnosed; however, the question is usually not asked again. At 6 months following diagnosis, when patients or their caregivers haven’t been working and they have depleted their savings to pay for their treatment and attend their visits, perhaps the question should be asked again, concludes Goldberg.

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Stuart L. Goldberg, MD, discusses financial toxicities faced in hematology. 

Dr. Goldberg on Financial Toxicities Faced in Hematology

Stuart L. Goldberg, MD, hematologist, John Theurer Cancer Center, discusses the use of 4 FDA-approved agents for patients with acute myeloid leukemia (AML) with varying genetic alterations.

AML is an extremely complex disease at a genetic and chromosomal level. Traditionally, chromosomes have been used to determine whether a patient should get a bone marrow transplant, or whether they should go to consolidation chemotherapy for risk stratification. The introduction of molecular testing has helped determine which targeted therapy to give.

The history of the patient, is critical in determining which agent to give. CPX-351 (Vyxeos) may be the best option for a patient who has a history of myelodysplastic changes or second treatment. If a patient has a genetic alteration of 

, an upfront FLT3 inhibitor like midostaurin (Rydapt) may be better suited for the patient. In the second-line setting, some of the experimental agents may be considered. An 

 mutation may warrant the use of an IDH2 inhibitor, says Goldberg. If the patient has a core-binding factor, gemtuzumab ozogamicin (Mylotarg) may play a role.

Dr. Goldberg on FDA-Approved Agents for Patients With AML

Stuart L. Goldberg, MD, chief medical officer, John Theurer Cancer Center, discusses precision medicine for patients with hematologic malignancies.

The goal of precision medicine is to give the right patient the right treatment, explains Goldberg. If the patient receives the right therapy, it will make their quality and longevity of life better, and no money will be wasted, Goldberg adds.

It has been estimated that one-third of medicine is wasted, says Goldberg. If physicians use precision medicine properly, their patients will benefit, see the true value of the drug, and will not receive lines of ineffective therapies.

Stuart L. Goldberg, MD

Articles

Dr. Goldberg on Financial Toxicities Faced in Hematology

Dr. Goldberg on FDA-Approved Agents for Patients With AML

Dr. Goldberg on Precision Medicine in Hematologic Malignancies