Development and Prospective Validation of a Rapid Financial Toxicity Screening Instrument for Radiation Oncology Patients

Abstract

Cancer is among the most costly medical conditions to treat due in part to the escalating price of therapies coupled with the prevalence of out-of-pocket expenses associated with fee-for-service reimbursement. The growing burden of financial toxicity on patients has increasingly been recognized as a side effect, which can contribute to distress. Despite this, the implementation of screening instruments for financial toxicity has been relatively limited. The aim of this study was to evaluate the performance of a rapid screening tool, which could potentially be adopted for routine and practical use. We hypothesize the rapid screening tool will be reliable within the radiation oncology clinic. After approval from the Institutional Review Board, a customized rapid screening tool for financial toxicity was prospectively administered to patients with a histological diagnosis of cancer at a tertiary care-based radiation oncology clinic. The “RAPID-FT” screening tool was developed using previously validated measures and explored five domains related to monetary debt, assistance from caregivers, changes in employment for the patient and caregivers, and overall financial distress. The possible scores for the “RAPID-FT” ranged from 0 (no burden) to 20 (most burden). Findings were correlated to answers from the concurrently administered Comprehensive Score of Financial Toxicity (COST), a screening instrument (scored from 0 to 44) which had been previously validated in the medical oncology setting. Patients were informed that all results would be reviewed anonymously and would not affect subsequent medical care. Goodness of fit models were constructed for statistical analysis with a p-value of 0.05 set for significance. A total of 33 patients (45% male; 55% female) completed the “RAPID-FT” and the COST questionnaires. The median age was 61 years (range, 33-88). Ethnicity was: 29 White; 2 Black; 1 Hispanic; 1 Asian. Twenty-eight (85%) and 5 patients (15%) were referred for definitive and palliative radiation, respectively. The most common disease sites were head and neck (8 patients), lung (7 patients), and gynecologic (6 patients). The approximate mean time to complete the “RAPID-FT” and COST surveys was 3 minutes and 7 minutes, respectively. Among all patients, 69% had Medicare, 21% had private insurance, and 6% had no insurance. The “RAPID-FT” and COST scores ranged from 0 to 10 and 6 to 40, respectively. The mean score using the “RAPID-FT” and COST instruments were 8.1 ± 5.2 and 24.3 ± 11.0, respectively. A significant correlation was identified between the “RAPID-FT” and COST scores (p<0.001), and a high concordance was established with each patient serving as their own control and data sorted into quartiles. The feasibility of rapid screening for financial toxicity was demonstrated, and the proposed 5-part instrument proved to be reliable and efficient in the radiation oncology clinic. Additional studies with longitudinal follow-up are planned.