This article was translated from Italian. The original version is available on the GIMEMA website at the following link: https://www.gimema.it/qualita-della-vita-tossicita-finanziaria-pazienti-leucemia-mieloide-cronica-reddito-pro-capite-conta/
A study conducted on Ethiopian patients affected by chronic myeloid leukemia (CML) shows that in poorer countries the perceived quality of life is lower compared to that of richer countries, and it may be influenced by economic-related problems.
Over the past ten years, the treatment of chronic myeloid leukemia has made important progress thanks to the introduction of targeted therapies that have significantly improved prognosis and perceived quality of life. However, most of the data on quality of life refer to patients living in countries with a high per capita income, according to the World Bank classification, and little is known about patients who face the disease in countries with a lower per capita income. But if data from the latter were to be analyzed, could the different economic conditions influence quality of life? It would seem so: this is what emerges from a study conducted at the Tikur Anbessa Hospital in Addis Ababa, Ethiopia, in collaboration with GIMEMA, and published in the journal JCO Global Oncology.
Through a case-control analysis, the study aimed to compare the quality of life of Ethiopian patients with CML with that perceived by a similar group of Italian patients.
Furthermore, as a secondary objective, the association between quality of life and financial toxicity reported by Ethiopian patients was evaluated, identifying the factors that cause such toxicity. This concept includes a combination of direct costs, such as expenses for drugs and medical visits, and indirect costs, such as transportation expenses.
Between February and June 2021, 395 Ethiopian patients with CML were enrolled, all receiving treatment with tyrosine kinase inhibitors. Patients were asked to answer the questions of the quality-of-life questionnaires of the European Organisation for Research and Treatment of Cancer, EORTC QLQ-C30 and EORTC QLQ-CML24, the latter being specific for patients affected by CML. The questions address symptom burden, the impact of the disease on daily life and mood, satisfaction with the care received, and with one’s social life. Financial toxicity was measured using the financial difficulties item of the EORTC QLQ-C30.
Overall, Ethiopian patients reported a lower quality of life, with a higher symptom burden and greater financial difficulties compared to the control group of Italian patients.
In Ethiopia, exactly as in Italy, the costs for tyrosine kinase inhibitor drugs are not borne by patients. Financial toxicity was detected in more than 89% of Ethiopian patients with chronic myeloid leukemia, mostly associated with distance from the hospital and household income. In particular, the study found that two-thirds of the enrolled CML patients had to travel more than 100 km to undergo treatments and follow-up visits, with a financial burden to cover travel and accommodation expenses that is not always compatible with the average salaries of Ethiopian families.
Patients with financial toxicity also showed a higher prevalence of clinically relevant problems and symptoms, probably worsened by the difficulty in purchasing supportive medications.
In conclusion, the results of the study suggest not only that patients with chronic myeloid leukemia living in countries with a low per capita income have a worse level of quality of life compared to patients with CML living in high-income countries, but also that contributing to this disparity may be financial-related problems, which would worsen the health of patients with a lower socio-economic status.