Validating a simplified financial toxicity screening tool for patients with cancer.

Abstract

318 Background: Medical-related financial hardship (called financial toxicity) can negatively impact patient clinical outcomes and overall well-being. Routine financial toxicity screening is recommended to facilitate referrals to resources for patients experiencing, or at risk for, financial toxicity. The validated Comprehensive Score for Financial Toxicity (COST) tool is widely used in research to measure financial toxicity; however, its 11-question length and lack of standardized screening threshold make it challenging to implement in clinical practice. This analysis sought to develop and validate an abbreviated version of the tool, suitable for routine screening in clinical practice. Methods: The full COST was administered as part of clinical care from June 2022-August 2023. Patients receiving treatment for breast, gynecologic, thoracic, or gastrointestinal cancer at an urban comprehensive cancer center were queried via patient portal or in clinic. Using 38,330 observations, we calculated the correlation of abbreviated tools of varying length with the full COST score (0-44, lower scores=higher FT). We then used a validation dataset of 19,196 observations to assess the positive and negative predictive values (PPV, NPV) of an abbreviated tool against the full COST score, when compared to thresholds for risk previously used in the literature (score ≤15, ≤20). Results: Including two questions (Q3: “I worry about the financial problems I will have in the future as a result of my illness or treatment”; Q6: “I am satisfied with my current financial situation”) yielded r=0.922 correlation with the full COST. For this 2-item tool, PPV ranged from 74-91%, and NPV ranged from 91-98% when compared to the full COST tool. Table 1 shows the PPV and NPV of varying score thresholds for the abbreviated COST against full scores ≤15 and ≤20. Conclusions: Using a large and clinically diverse sample of patients with cancer,we demonstrate the predictive value of an abbreviated COST tool and show its approximate accuracy when compared to the full tool. Simplified, clinically integratedscreening for financial hardship can efficiently ensure appropriate intervention for patients experiencing medical-related financial hardship and can also be a first step toward mitigating hardship among those at risk for developing it. Predictive value of 2-item COST vs. full COST score in the validation set. Full COST score ≤ 15 Yes No 2-question, COST score ≤ 1 Yes 2337 (14%) 253 (1.5%) PPV = 90% No 822 (4.8%) 13844 (80%) 1-NPV = 5.6% Full COST score ≤ 15 Yes No 2-question, COST score ≤ 2 Yes 2924 (17%) 1045 (6.1%) PPV = 74% No 235 (1.4%) 13052 (76%) 1-NPV = 1.8% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 2 Yes 3626 (21%) 343 (2.0%) PPV = 91% No 1199 (6.9%) 12088 (70%) 1-NPV = 9.0% Full COST score ≤ 20 Yes No 2-question, COST score ≤ 3 Yes 4359 (25%) 1272 (7.4%) PPV = 77% No 466 (2.7%) 11159 (65%) 1-NPV = 4.0%