Limitations
As with any questionnaire study, the self-response format used in this study was a limitation because the sickest or most affected patients may not have participated. Additionally, answers to financial questions were subjective, and we did not have confirmation from objective measurements. A longitudinal study might provide different results, given that studies of other cancers have demonstrated improvement in work-related disability after 18 months. The 5-year survival rate for patients with MM is 40% or less, and patients have only recently begun living long enough to complete the usual 2 to 3 years of treatment and face decisions about return to work and other long-range financial issues. Therefore, limited data are available with which to compare our results. Nevertheless, the 76% response rate to the survey is probably a good indication that patients with MM experience negative financial effects from MM treatment, and they want their voices heard through their narrative comments that described hardships: changes in employment status and insurance coverage, loss of home or retirement savings, and difficult choices of managing day-to-day expenses in the shadows of mounting out-of-pocket costs and decreased income.