Abstract
PurposeFinancial toxicity is highly prevalent in oncology. Early identification of at-risk patients is essential because financial toxicity is associated with inferior outcomes. Validated general oncology screening tools are cumbersome and not specific to challenges related to radiation therapy, such as daily treatments. In the population of radiation oncology patients, no standardized, validated, rapid screening tool exists. We sought to develop a rapid, no-cost, and reliable financial-toxicity screening tool for clinical radiation oncology. Methods and MaterialsWe retrospectively analyzed data from a prospective survey study conducted at a large referral center with a heterogeneous population. Before treatment, a 25-item modified comprehensive survey for financial toxicity incorporating subjective and objective patient-reported measures was administered to identify factors linked to the risk of developing financial toxicity, which was defined as radiation therapy resulting in any of the following: loss of income, job, or spouse or difficulty paying for meals, housing, or transportation. We applied a logistic regression model with a stepwise, backward model selection procedure. Estimated probabilities of experiencing financial toxicity were computed using the inverse-logit transformation of the sum of patient-specific predictor values multiplied by the coefficients of the selected logistic regression model. The Youden index was used to determine a reasonable risk threshold. ResultsA total of 157 patients completed the questionnaire, and 34 (22%) were assessed as experiencing financial toxicity. The model retained 3 factors: age, money owed, and copayment-related worries. It resulted in a concordance statistic of 0.85, developed with a risk threshold of 18% (Youden index, 0.59). This model conferred a sensitivity of 89%, specificity of 70%, positive predictive value of 44%, and negative predictive value of 96%. ConclusionsOur proposed financial-toxicity screen is rapid, free, sensitive, and specific, and in this study, it identified early-onset, patient-reported financial toxicity after radiation therapy with just 3 simple variables: age, money owed, and copayment-related concerns. Future research steps should include a validation cohort and identification of interventions to mitigate financial toxicity.
Highlights
The financial implications of cancer-related therapy are a significant concern for the majority of oncology patients.[1,2] Some studies have shown that up to 75% of patients with cancer struggle to make copayments,[3] approximately 20% improperly take prescribed medications to defray costs,[3] and these patients are more than twice as likely to file for bankruptcy than are patients without cancer.[4]
A patient-reported outcome measure called the comprehensive score for financial toxicity (COST) has been previously validated in the general oncology population,[10] but the proportion of financial issues in this population that are attributable to radiation therapy is not well established
We surveyed more than 200 radiation oncologists; 53% reported “significant concern” about the effect of treatment-related costs on patients and 80% citied a clinical need for a reliable screening tool for financial toxicity.[11]
Summary
The financial implications of cancer-related therapy are a significant concern for the majority of oncology patients.[1,2] Some studies have shown that up to 75% of patients with cancer struggle to make copayments,[3] approximately 20% improperly take prescribed medications to defray costs,[3] and these patients are more than twice as likely to file for bankruptcy than are patients without cancer.[4]. To assess the risk of financial distress associated with radiation therapy, we previously conducted a prospective pilot study at a large tertiary-care center with a heterogeneous patient population and found that nearly one-fourth of radiation oncology patients reported financial toxicity attributable to their care.[11] At that time, we surveyed more than 200 radiation oncologists; 53% reported “significant concern” about the effect of treatment-related costs on patients and 80% citied a clinical need for a reliable screening tool for financial toxicity.[11] Despite these concerns, to our knowledge, there is no standardized, validated, screening tool tailored to predict financial distress from radiation therapy. To fill this unmet need for a simple, cost effective, reliable screening tool, we conducted a secondary analysis of our previously reported prospective survey study
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