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Smoldering Myeloma and Financial Toxicity
Why do I mean by the phrase “smoldering myeloma and financial toxicity?” Pre-myeloma classifications such as a single plasmacytoma of bone, MGUS and SMM (smoldering myeloma) are not cancer… they are not myeloma. They are diagnostic stages of “pre-myeloma.”
Pre-cancers like DCIS, colon polyps, Barrett’s Esophagus, non-melanoma skin cancers, etc. etc.
As such, these stages do not require conventional treatments such as surgery, chemo or radiation. There are no FDA approved therapies for pre-myeloma because they aren’t cancer.
If the FDA has not approved therapy for pre-myeloma then your health insurance plan may not cover therapy for pre-myeloma. If your health insurance doesn’t pay for pre-myeloma therapies, if you are a pre-myeloma patient who undergoes therapies, you may be on-the-hook for thousands of dollars in medical expenses.
Remember that once the patient begins undergoing therapy, in all likelihood, you will be in and out of chemotherapy for years if not decades. Even if you are in a clinical trial at first, there may come a time when you are no longer in the trial but require treatment.
This is what I mean by financial toxicity.
Two important points:
- Active chemo will usually delay SMM from becoming full MM
- High-risk SMM will probably progress to full MM eventually
There is no evidence that I know of, no studies that find that any SMM patient is cured of MM. Early treatment of SMM defers a diagnosis of full MM.
Smoldering Multiple Myeloma Management Hinges on the Debate Between Treatment and Observation
“In a prospective, randomized study led by Lonial, early intervention with lenalidomide (Revlimid) in patients with smoldering MM led to significant deferment in patients’ progression to symptomatic MM and end-organ damage…4″
If you are diagnosed with high-risk SMM, what should you do?
According to research, pre-habilitation before treatment means that the patient can achieve a better functional response to chemo.
Further, if the SMM patient progresses to full MM, the patient will be early stage MM. According to research, the 5% of NDMM patients who are stage 1 have a much better prognosis than the stage 2,3 NDMM patients.
My point is that it is in the best interests of high-risk SMM patients to pre-habilitate before undergoing conventional treatment. And those SMM patients may never progress to full MM.
Make no mistake. The thought of postponing or possibly curing your pre-myeloma is intoxicating. At the same time, as the cliche goes, Myeloma is a marathon, not a sprint. Once the SMM patient begins active treatment, he/she may have to treat for life.
I’m not saying that high-risk SMM patients should not begin treatment. I’m saying that before anyone with pre-myeloma should read the…what is it called, a “certificate of coverage” or something like that. In other words, figure out if an elective/experimental procedure/therapy and all the associated costs, are covered.
Are you a newly diagnosed myeloma patient? Have you been diagnosed with high-risk smoldering multiple myeloma? Send me an email if you’d like to learn more about evidence-based therapies that can reduce your risk of a diagnosis of multiple myeloma. David.PeopleBeatingCancer@gmail.com
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Cancer patients shouldn’t be responsible for out-of-pocket costs
“By May 23, 2023
In 2023, just under 2 million Americans will be diagnosed with cancer. Many will endure multiple CT and MRI studies and intensive medical care, including surgery, radiation, chemotherapy, or immunotherapy…
Unfortunately, many American cancer patients also face an unexpected adverse effect: financial toxicity. The costs of cancer are literally killing patients…
Financial toxicity is the economic burden patients experience from the costs related to getting treatment for their cancer. Cancer care is expensive. By one 2020 estimate, the average cost of medical care and drugs is more than $42,000 in the year following a cancer diagnosis…
Consequently, more than 40% of patients spend their entire life savings in the first two years of treatment, while roughly 30% of Americans with a cancer history report having had problems paying their medical bills, having to borrow money, or filing for bankruptcy protection because of their cancer…
Much of this financial toxicity, which is increasingly common, is occurring for patients with health insurance coverage…
One reason for this is higher health care prices, particularly for hospital care and cancer chemotherapies. Another is employers’ increasing reliance on high-deductible health plans, as well as health plans with high coinsurance and copayment rates, that make cancer patients shoulder more and more of ever greater costs of their care, especially for specialty drugs. This model makes no sense — financially or medically…
Financial toxicity is uniquely American. Cancer patients in other countries do not experience this side effect. For instance, Germany limits the out-of-pocket costs for chronically ill patients to 1% of their income. In Norway, patients are responsible for a maximum of $281 for out-of-pocket payments annually, and then they are exempt from any copays or other costs. In Canada, patients can see any primary care physician and any referred specialist with no cost sharing, and there is no copay for hospitalizations…
There must be safeguards to prevent abuse. Patients should receive only evidence-based treatment, and doctors should choose the most cost-effective treatment option. For instance, cancer patients with bone metastases could be treated with denosumab, a monoclonal antibody, but the cost sharing should only be eliminated for the equally effective Zometa, which costs approximately $24,000 less per year for each patient…
Greater physician financial accountability has precedent, too. Under value-based programs, physicians’ financial incentives are tied to the quality of care that patients receive, with the underlying goals of improving population health and reducing spending. If physicians opt to recommend unnecessary services or more expensive treatments when there is an equally good one that is lower cost, they should face financial penalties…
Similarly, when there are multiple National Comprehensive Cancer Network-approved chemotherapy treatments of equal efficacy for a particular cancer, oncologists should receive the payment for the lowest cost option regardless of the regimen they administer…
It is calculated that all American cancer patients, including survivors long after they received their cancer treatments, pay about $16 billion in out-of-pocket costs for their cancer care, or about 8% of all costs for cancer care…