Journal of Cancer Research and Clinical Oncology

, Volume 143, Issue 12, pp 2619–2630 | Cite as

Higher out-of-pocket expenses for tyrosine kinase-inhibitor therapy is associated with worse health-related quality-of-life in persons with chronic myeloid leukemia

  • Qian JiangEmail author
  • Haibo Wang
  • Lu Yu
  • Robert Peter Gale
Original Article – Clinical Oncology



To explore health-related quality-of-life (HRQoL) profiles and identify socio-demographic and clinical variables associated with HRQoL in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs).


A cross-sectional questionnaire was distributed to adults with chronic-phase CML receiving tyrosine kinase-inhibitor (TKI) therapy >3 months in complete cytogenetic response (CCyR). Respondents were anonymous. SF-36 Health Survey was used to measure HRQoL.


Data from 828 respondents were analyzable. 524 (63%) were male. Median age was 42 years (range 18–88 years). 648 (78%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3–178 months). 638 (77%) paid some or all of their TKI costs. Annual out-of-pocket expenses >$4600 USD was associated with lower physical component summary (PCS; −2.8 to −3.8; P = 0.0081 and 0.0009) and mental component summary (MCS; −2.1 to −4.3; P = 0.0394 and 0.0080) in multivariate analyses. Other variables significantly associated with a lower PCS and/or MCS included: (1) female sex; (2) increasing age; (3) education level < bachelor degree; (4) co-morbidity(ies); and (5) generic drug use. TKI-therapy duration 3–5 years was associated with higher PCS and MCS.


Higher out-of-pocket expense for TKI therapy is significantly associated with worse HRQoL in persons with chronic-phase CML in CCyR receiving TKI therapy. These data indicate the importance of drug cost and health insurance policies on people’s HRQoL.


Chronic Leukemia Health-related quality-of-life Tyrosine kinase inhibitor 



We graduated the New Sunshine Charity Foundation which helped to distribute and collect the questionnaires. This study was funded by National Natural Science Foundation of China (no. 81370637).

Compliance with ethical standards

Conflict of interest

RPG is a part-time employee of Celgene Corporation, Summit, NJ, USA. The remaining authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

432_2017_2517_MOESM1_ESM.pdf (312 kb)
Supplementary material 1 (PDF 312 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Peking University People’s Hospital, Peking University Institute of HematologyBeijingPeople’s Republic of China
  2. 2.Collaborative Innovation Center of HematologySoochow UniversitySuzhouPeople’s Republic of China
  3. 3.Peking University Clinical Research InstituteBeijingPeople’s Republic of China
  4. 4.Haematology Research Centre, Division of Experimental Medicine, Department of MedicineImperial College LondonLondonUK

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