Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2)

Dorothy N S Chan,Kai Chow Choi,Wai Man Ling,Suzanne S S Mak,Maggie Chan,Mandy Chan,Bernard M H Law,Cecilia Au,Man Tong,Winnie K W So,Raymond J Chan,Marques S N Ng,Weijie Xing,Pui Shan Ho

doi:10.1186/s12955-020-01646-z

Abstract

BackgroundCancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties.MethodsThe Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test–retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use.ResultsThe COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach’s alpha, 0.86) and acceptable test–retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = − 0.23 to − 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use.ConclusionsThe COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients’ level of financial toxicity.

Highlights

Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress
The original version of the COST-FACIT-v2 was translated from English into traditional Chinese following the Functional Assessment of Chronic Illness Therapy (FACIT) translation method [13, 14] and tested for content validity
Two experts commented that item 4 (‘I feel I have no choice about the amount of money I spend on care’) would better be written as ‘I feel it is necessary for me to spend the amount of money on care’, and they thought it would be understood by patients

Summary

Introduction

Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial ToxicityFunctional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. In one review [3], 28% to 48% of cancer patients reported financial distress in monetary terms, 16% to 73% experienced a subjective burden of this distress. The objective and subjective burdens of this financial distress in the context of cancer have been termed ‘financial toxicity’ [4]. A high level of financial toxicity has been demonstrated to increase patients’ symptom burden [5] and reduce their compliance to therapy, health-related quality of life (HRQoL) and survival rate [2, 6]. A systematic assessment of financial toxicity may help to initiate such discussions and to identify patients who need financial support [7]

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