Cancer and its treatments lead to financial toxicity for patients, according to cancer specialists who reported the findings from using the Comprehensive Score for Financial Toxicity (COST) questionnaire in Cancer. The study confirmed that COST is a clinically relevant patient-centered tool that can assess patient’s risk for, and ability to tolerate, financial stress.
The study included 233 patients diagnosed with a stage IV solid tumor who had been receiving chemotherapy for at least 2 months. The researchers gathered data on patient characteristics, clinical trial participations, health care use, willingness to discuss costs, psychological distress, and health-related quality of life (HRQoL). The COST questionnaire is short and includes 11 brief statements about costs, resources, and concerns. For each question, patients were asked to circle one of five possible responses that help determine their level of concern.
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“As expected, we found a strong association between a patient’s use of health care resources and his or her sense of financial toxicity,” said the study’s lead author Jonas de Souza, MD, MBA, head-and-neck cancer specialist and health services researcher at the University of Chicago Medicine, in a statement.“This is something we need to look for, to recognize early, and make sure it does not become a barrier to care.”
The questionnaires revealed several factors that were closely tied to financial toxicity. COST values were found to be correlated with income (correlation coefficient [r], 0.28; P<.001), psychosocial stress (r= -0.26; P<.001), and HRQoL, as measured by the Functional Assessment of Cancer Therapy: General (r=0.42; P<.001), and by the European Organization for Research and Treatment of Cancer QOL instruments (r=0.33; P<.001). Other factors associated with financial toxicity included race, employment status, income, number of inpatient admissions, and psychological distress.
A surprise finding from the study was the lack of perceived financial benefit from participation in clinical trials. “Usually the maker of an innovative device or the company that supplies a new drug will pick up the costs related to the investigational drug,” Dr de Souza said. “But that did not reduce our patients’ sense of financial toxicity. We’ve added that to our model.”
