Financial toxicity and health-related quality of life in long-term survivors of acute promyelocytic leukaemia

BMJ Support Palliat Care. 2025 Jun 27;15(4):530-534. doi: 10.1136/spcare-2024-004924.

Abstract

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.

Keywords: Leukaemia; Quality of life; Survivorship.

MeSH terms

  • Adult
  • Aged
  • Cancer Survivors* / psychology
  • Cancer Survivors* / statistics & numerical data
  • Female
  • Financial Stress*
  • Humans
  • Leukemia, Promyelocytic, Acute* / economics
  • Leukemia, Promyelocytic, Acute* / psychology
  • Male
  • Middle Aged
  • Quality of Life* / psychology
  • Surveys and Questionnaires
  • Survivors* / psychology