Financial Burden for Blood or Marrow Transplantation Survivors During the COVID-19 Pandemic

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In an analysis from the BMT Survivor Study (BMTSS) reported in the Journal of Clinical Oncology, Smita Bhatia, MD, MPH, and colleagues found that survivors of blood or marrow transplantation (BMT) were more likely to have high out-of-pocket medical costs vs comparator siblings during the COVID-19 pandemic. High out-of-pocket costs among survivors were associated with increased likelihood of deferring care, taking reduced doses of medication, and considering filing for bankruptcy.

Smita Bhatia, MD, MPH

Smita Bhatia, MD, MPH

Study Details

The study included 2,370 BMT survivors and 750 siblings who completed the BMTSS survey during the pandemic. Participants reported employment status, out-of-pocket medical costs, and financial burden. High out-of-pocket medical costs were defined as medical expenses costing 10% or more than that of the annual household income.

Key Findings

BMT survivors were more likely vs siblings to have high out-of-pocket medical costs (11.3% vs 3.1%; adjusted odds ratio [aOR] = 2.88, 95% confidence interval [CI] = 1.84–4.50, P < .001).

Examples of proportions of survivors with vs without high out-of-pocket costs and siblings reporting hardship or worries, respectively, included:

  • Unable to pay for basics (food, heat, and rent): 26.5%, 9.2%, 8.3%
  • Took on credit card debt: 39.2%, 13.4%, 10.8%
  • Borrowed money: 25.0%, 6.5%, 6.5%
  • Needed uncovered health services: 46.3%, 13.9%, 12.5%
  • Did not fill a prescription: 22.8%, 3.3%, 2.9%
  • Worry about being unable to see health-care providers as needed: 42.5%, 15.6%, 15.9%
  • Worry about being unable to get a medical procedure: 44.0%, 14.8%, 14.5%
  • Skipped test, treatment, or follow-up: 28.4%, 6.1%, 6.9%. 

Survivors with high out-of-pocket expenses were at least twice as likely to postpone mental health, vision, dental, and preventive care.

Among survivors, factors significantly associated with high out-of-pocket costs included younger age at study participation (aOR for each year younger = 1.02, 95% CI = 1.00–1.03), lower prepandemic annual household income or level of education (aOR = 1.96, 95% CI = 1.42–2.69 for < $50,000 or < college graduate vs ≥ $50,000 or ≥ college graduate), more than one vs no chronic health condition (aOR = 2.82, 95% CI = 2.00–3.98), one or more vs no hospitalization(s) during the pandemic (aOR = 2.11, 95% CI = 1.53–2.89), and being unemployed during the pandemic (aOR = 1.52, 95% CI = 1.06–2.17).

Among survivors, high out-of-pocket medical costs were significantly associated with problems in paying medical bills (aOR = 10.57, 95% CI = 7.39–15.11), deferring medical care (aOR = 4.93, 95% CI = 3.71–6.55), taking smaller doses of medication than prescribed (aOR = 4.99, 95% CI = 3.23–7.70), and considering filing for bankruptcy (aOR = 3.80, 95% CI = 2.14–6.73).

The investigators concluded, “BMT survivors report high out-of-pocket medical costs, which jeopardizes their health care and may affect health outcomes. Policies aimed at reducing financial burden in BMT survivors, such as expanding access to patient assistance programs, may mitigate the negative health consequences.”

Dr. Bhatia, of the Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute and Leukemia and Lymphoma Society. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.