Jessica Allen MD

Lastly, the biggest thanks go to my mentor
@majorajay.bsky.social
, whose passion for PROs and quality of life investigation is incredibly inspiring. Thank you as well to everyone involved at The University of Chicago and @accordsresearch.bsky.social ! /end
bit.ly/3P4R0sy
#ASH24 #lymsm

Financial Toxicity, Health-Related Quality of Life, and Medication Adherence Patient-Reported Outcomes (PROs) in Patients with Chronic Lymphocytic Leukemia (CLL) on First-Line Oral Oncolytics Disclosures. Major:Roche/Genentech: Consultancy; Incyte: Research Funding.

Thank you for tuning in! This is a mid-study analysis, and we aim to enroll 75 patients before final analysis. We welcome any feedback and impressions from this study as enrollment continues! /14
bit.ly/3P4R0sy

This data also helps us counsel our pts before starting OOT. For example, looking back at HRQOL data, you can see that median FACT-LEU scores dipped at 3 months but increased to > baseline scores at 6 months. Pts might expect worse HRQOL initially, but it should get better! /13

Patients are at risk for FT regardless of out-of-pocket cost (no correlation between COST score and $0 copay), and qualitative data suggests that the uncertainty of future financial support for these often lifetime therapies drives FT /12

What does all of this mean and why is it important to clinicians?
- Patients on 1st line oral oncolytics for CLL are at risk for early and progressive FT AND suboptimal med adherence
- Patients in this group that experience FT are also likely to have worse HRQOL
/11

Take-aways from our qualitative analysis:
- Fear of losing financial assistance was very prevalent
- No one reported intentionally missing medications, but a few pts reported rare unintentional missed dose /10

Now let's look at how they all relate:
- FACIT-COST positively correlated with FACT-LEU score @ all time points
- FACIT-COST positively correlated with PROMIS-PMAS @ baseline
- Social wellbeing positively correlated with PMAS and MARS scores /9

The differences between FACT-LEU total median scores over time did not meet the minimally important difference threshold. When we looked at the components of FACT-LEU, emotional well-being and functional well-being had the lowest median scores at all timepoints. /8

PRO data for adherence similarly demonstrated increased suboptimal adherence behaviors over time. Interestingly, the MARS-5 and PROMIS-PMAS instruments tracked in the same direction, but were discrepant in the incidence of suboptimal adherence they caught. /7

In our PRO analysis, there was already a significant incidence of FT at baseline (22%), which increased over time. /6

47 patients completed PRO instruments at baseline. Longitudinal completion rates remained high (85% 3 mo, 83% 6mo).
- Median age 66, 53% male, 89% white
- 47% medicare, 45% private insurance
- 53% concurrent obinutuzumab
- 66% had $0 copay, 57% grant or PAP support
#ASH24
/5

To further validate these PRO instruments for CLL, we also conducted semi-structured interviews and used thematic analysis to assess concordance and discordance with PRO results. /4

The PROs we used to measure these variables were FACIT-COST for FT, FACT-LEU for health-related quality of life (HRQOL), and PROMIS-PMAS and MARS-5 for adherence. We measured at time of trial enrollment, 3 months, and 6 months /3

Why? Oral oncolytic therapy (OOT) is expensive! Out-of-pocket costs for patients with CLL are predicted to increase 520% by 2025. Additionally, financial toxicity (FT) has been associated with poor health-related quality of life and suboptimal adherence in other malignancies /2

Oral agents have changed the CLL treatment landscape. But how does their cost affect patients? Here's a review of our #ASH24 abstract on the relationship between financial toxicity, medication adherence, and health-related QOL in CLL pts on 1L oral therapy #lymsm 🧵/1
@majorajay.bsky.social

First pie baked at altitude… cherry pie a la Sally’s Baking Addiction using the Betty Crocker pie crust recipe! Presentation could use work but overall a success

Lee, et al. from Stanford present results in 24 octogenarians treated with CD19 CAR-T cells.

Overall, higher ICANS rate and much longer LOS (30d vs. 16d) v. age 65-79. Long LOS driven by toxicity.

Similar overall PFS, outcomes suggest safety/efficacy in selected patients. #ASH24 #immunotherapy

Slide on financial toxicity of cancer care

Staggering statistics at #ASH24 #TreatingFairly

Patients with cancer who go bankrupt are nearly 80% more likely to die regardless of disease status.

Our system quite literally kills people.

Can't congratulate Dr. Allen enough on her #ASH24 abstract; keep your eyes peeled for a manuscript in 2025! And the whole @cuanschutz.bsky.social internal med gang showed up, too! #ASHKudos #lymsm cc @jessicaallenmd.bsky.social @vpizzuti.bsky.social

Preview of my mentee Dr. Allen's (@jessicaallenmd.bsky.social) study at tonight's #ASH24 poster session. Patient-reported financial toxicity and suboptimal adherence is already substantial in the first few months of initiation of first-line oral oncolytics for CLL, and affects HRQOL. #lymsm #leusm

For #ASH24 goers, please check out our #lymsm PRO abstracts:
- Saturday PM: @jessicaallenmd.bsky.social presenting FT & adherence in 1L CLL oral oncolytics
- Monday PM: Dr. Pizzuti presenting heatmap modeling of longitudinal PROs from our BISON-PRO registry (bison-pro.org)

CU soon in San Diego for a fabulous weekend!! #ASH24

Kicking off for the University of Colorado team today is
Dr. Manali Kamdar.

For more CU team weekend activities: bit.ly/CUHematology...

#HemeOnc #Hematology #BloodSky

So excited to attend my first ASH! #ASH24
@ash-hematology.bsky.social