Employment, Insurance, and Financial Experiences of Patients with Chronic Graft-versus-Host Disease in North America

Nandita Khera, Betty K. Hamilton, Joseph A. Pidala, William A. Wood, Vicky Wu, Jenna Voutsinas, Lynn Onstad, Amin M. Alousi, Raewyn Broady, George L. Chen, Mukta Arora, Corey Cutler, Mary E. Flowers, Alex Ganetsky, Madan Jagasia, Philip L. McCarthy, Stefanie Sarantopoulos, Gregory A. Abel, Navneet S. Majhail, Stephanie J. Lee

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Understanding the socioeconomic impact of chronic graft-versus-host disease (GVHD) on affected patients is essential to help improve their overall well-being. Using data from the Chronic GVHD Consortium, we describe the insurance, employment, and financial challenges faced by these patients and the factors associated with the ability to work/attend school and associated financial burdens. A 15-item cross-sectional questionnaire designed to measure financial concerns, income, employment, and insurance was completed by 190 patients (response rate, 68%; 10 centers) enrolled on a multicenter Chronic GVHD Consortium Response Measures Validation Study. Multivariable logistic regression models examined the factors associated with financial burden and ability to work/attend school. The median age of respondents was 56years, and 87% of the patients were white. A higher proportion of nonrespondents had lower income before hematopoietic cell transplantation and less than a college degree. All but 1 patient had insurance, 34% had faced delayed/denied insurance coverage for chronic GVHD treatments, and 66% reported a financial burden. Patients with a financial burden had greater depression/anxiety and difficulty sleeping. Nonwhite race, lower mental functioning, and lower activity score were associated with a greater likelihood of financial burden. Younger age, early risk disease, and higher mental functioning were associated with a greater likelihood of being able to work/attend school. In this multicenter cohort of patients with chronic GVHD, significant negative effects on finances were observed even with health insurance coverage. Future research should investigate potential interventions to provide optimal and affordable care to at-risk patients and prevent long-term adverse financial outcomes in this vulnerable group.

Original languageEnglish (US)
Pages (from-to)599-605
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Issue number3
StatePublished - Mar 2019

Bibliographical note

Funding Information:
Financial disclosure: This study was funded by the National Cancer Institute (Grant CA118953 ).

Publisher Copyright:
© 2018 American Society for Blood and Marrow Transplantation


  • Financial hardship
  • chronic GVHD
  • hematopoietic cell transplantation


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