Comprehensive Score For Financial Toxicity Research Articles

The impact of humanitarian aid on financial toxicity among cancer patients in Northwest Syria

IntroductionThe ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions.Materials and methodsThis research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts.ResultsA total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress.ConclusionThe research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.

Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients

ObjectivesTo evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening. MethodsWe screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening. ResultsOf 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening. ConclusionsDedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.

Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity

ObjectiveThis study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. MethodsA total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants’ gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. ResultsThe CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. ConclusionsThe COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.

Prevalence of and Factors Associated with Financial Toxicity After Pancreatectomy and Gastrectomy.

Financial toxicity (FT) refers to the adverse impact of cancer treatment costs on patients' experiences, potentially leading to poor adherence to treatment and outcomes. However, the prevalence of FT among patients undergoing major upper gastrointestinal cancer operations, as well as factors associated with FT, remain unclear. We conducted a cross-sectional study by sending the Comprehensive Score for financial Toxicity (COST) survey and Surgery-Q (a survey specifically developed for this study) to patients who underwent gastrectomy or pancreatectomy for malignant disease at our institution in 2019-2021. We sent the surveys to 627 patients and received responses from 101 (16%) patients. The FT prevalence (COST score <26) was 48 (48%). Patients likely to experience FT were younger than 50years of age, of non-White race, earned an annual income <$75,000, and had credit scores <740 (all p<0.05). Additionally, longer hospital stay (p=0.041), extended time off work for surgery (p=0.011), and extended time off work for caregivers (p=0.005) were associated with FT. Procedure type was not associated with FT; however, patients who underwent minimally invasive surgery (MIS) had a lower FT probability (p=0.042). In a multivariable analysis, age <50years (p=0.031) and credit score <740 (p<0.001) were associated with high FT risk, while MIS was associated with low FT risk (p=0.024). Patients with upper gastrointestinal cancer have a major risk of FT. In addition to predicting the FT risk before surgery, facilitating quicker functional recovery with the appropriate use of MIS is considered important to reducing the FT risk.

Abstract 4827: Financial toxicity among cancer survivors during the COVID-19 pandemic

Abstract Background: Financial toxicity (FT), the financial impact of cancer and its treatments on patients’ employment, income, and health insurance, can have significant short- and long-term consequences for cancer survivors. With significant increases in cancer survivorship and the changing demographics of the United States, a need exists to identify those most susceptible to FT. This study evaluated FT prevalence during the COVID-19 pandemic and identified factors associated with greater FT risk. Methods: Data were collected from 1,147 cancer survivors recruited from previous National Cancer Institute-funded studies, from electronic health record searches for patients with cancer diagnoses at University of California, San Francisco (UCSF) and Mount Sinai Medical Center and Columbia University Medical Center in New York City, and the Dr. Susan Love Foundation for Breast Cancer Research. Adults, diagnosed with cancer and proficient in English, completed an online survey via the Research Electronic Data Capture (REDCap) system between May 27, 2020 and February 21, 2021. FT was assessed for the past 14 days using the validated 11-item COmprehensive Score for financial Toxicity (COST) measure. Patients were categorized by score: no FT (COST scores &amp;gt;25), mild FT (14-25), and moderate/severe FT (0-13). Using Pearson’s chi-square test of independence, and univariate ordinal logistic regression, the study evaluated sociodemographic and clinical characteristics associated with FT, including age, race and ethnicity, gender, household income, education, marital status, health insurance status, and cancer site. Results: The COST measure had excellent reliability for the sample (Cronbach’s alpha = 0.911). Overall, 9% of respondents reported moderate/severe FT (MSFT), 16% mild. Race/ethnicity, education level, annual household income, cancer site, and years from diagnosis (p-values ≤ 0.035) were associated with FT. Current health insurance coverage was not associated with FT (p=0.456). 18% Black, 13% Asian American, 17% mixed, and 20% other races/ethnicities reported MSFT, while 8% non-Hispanic White and 5% Hispanic respondents reported the same. 31% of survivors with annual household income &amp;lt;$40,000 reported MSFT vs. 7% with ≥$40,000 income. 14% of survivors with less than a college degree reported MSFT vs. 8% amongst those with a college degree or higher. For men, the odds of having FT (mild or MSFT) were 0.60 (95% CI 0.40, 0.90) times that of women. Survivors &amp;lt;50 years old at diagnosis had 7.53 (95% CI 4.09, 13.83) times the odds of FT (mild or MSFT) vs. those aged ≥75 years. Conclusions: These preliminary analyses from this cross-sectional study characterizes the prevalence and determinants of FT experienced by cancer survivors during the COVID-19 pandemic. The next steps will include multivariable analysis and comparison with pre-pandemic data, to identify those at greatest risk and inform interventions. Citation Format: Tanvi Srivastava, Salma Shariff-Marco, Samuel L. Washington, Christine Miaskowski, June M. Chan. Financial toxicity among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4827.

Mixed-Methods Study on the Responsiveness of the Comprehensive Score for Financial Toxicity Among People With Multiple Myeloma.

Financial toxicity is a contributor to the psychosocial burden of cancer care. There is no consensus measure of financial toxicity; however, recent studies have adopted the Comprehensive Score for Financial Toxicity (COST). Despite its growing popularity, data on the responsiveness to change of the COST instrument are lacking. To address this gap in the literature, we performed a sequential mixed-methods study of people with multiple myeloma. In the quantitative phase of the study, we collected COST scores at two time points approximately 8 weeks apart from 72 patients. In the qualitative phase, we conducted semistructured interviews with a subset of 12 patients who reported the largest changes in scores. The qualitative data were analyzed using a deductive coding scheme developed using the Framework Method in the context of a commonly cited conceptual model of financial toxicity. The median absolute change in COST scores was four points (IQR, 2-6). Only 13% of the sample had the same COST scores at both assessments; 38% had an improved score and 50% had a worsened score. Only, seven of the 12 patients (58%) interviewed reported changes to one or more of the constructs in the conceptual model of financial toxicity. Most commonly, changes to out-of-pocket medical costs were reported (5/12). Changes to nonmedical expenses (n = 2) and subjective financial distress without changes to objective financial burden (n = 2) were also reported. Additional research is needed to explicate changes in COST scores over time.

Abstract A001: Financial toxicity and social needs in patients with ovarian cancer: a multi-practice survey

Abstract Background: Treatment of ovarian cancer often involves expensive, sequential treatments, such as chemotherapy and surgery followed by long-term maintenance therapy. The direct and indirect costs of these treatments may create a significant financial burden and new care needs for patients. Our objective was to characterize financial toxicity and social needs in patients with ovarian cancer seen in a multi-practice health system. Methods: Patients in the University of Pennsylvania gynecologic oncology practices from January 2020 to February 2022 who had a patient portal account (n=6,925) were surveyed twice between March and April 2022, on financial toxicity. Those with ovarian cancer were included in this study. The survey included the 11-item Comprehensive Score for Financial Toxicity (COST) tool and a social needs question, “What service would be of most benefit to you in reducing financial toxicity of your treatment?” Responses were categorized as: very important; important; slightly important; and not at all important. We defined responses of “very important” and “important” as meeting high social need. Chi-squared and z-tests were used to compare differences between patients reporting high (COST&amp;lt; 26) and low (COST ≥26) financial toxicity. Results: 111 of 498 survey respondents identified as having ovarian cancer. The median COST score was 29 (range 6-44). 39% (n=37) had high financial toxicity, and 7% (7) had severe financial toxicity (COST&amp;lt;14). 19%(18) described their ovarian cancer as causing financial hardship to them and their family. 48% (26) of patients with private insurance and 48% (25) of patients under age 65 experienced high financial toxicity. Patients with private insurance were more likely to experience high financial toxicity (p=0.03) compared to patients with Medicare. Younger patients were more likely to experience high financial toxicity (p&amp;lt;0.001). Patients who were unemployed were more likely to experience high financial toxicity than those who were employed (p&amp;lt;0.001). Patients reported assistance with indirect costs of care (e.g., lost work) would be the most helpful in reducing financial toxicity (36%, 38) followed by assistance with out-of-pocket costs (29%, 31); housing and heating costs (27%, 28); and transportation (22%, 23). Conclusions: In a multi-practice survey, 39% of patients with ovarian cancer experienced financial toxicity, and 19% experienced financial hardship due to their cancer. Half of patients under age 65 and half of privately insured patients experienced financial toxicity. Patients identified assistance with direct and indirect costs of care (e.g., lost work, out-of-pocket costs) as the most helpful interventions. Interventions to address social needs and reduce financial toxicity are needed for patients with ovarian cancer. Citation Format: Anna Jo B. Smith, Maya H. Sharma, Kristina Powell, Meredith Doherty, Stefanie N. Hinkle, Emily M. Ko. Financial toxicity and social needs in patients with ovarian cancer: a multi-practice survey [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A001.

Abstract A005: The cause behind the COST – exploring qualitative and quantitative aspects of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer

Abstract Objective: To evaluate the prevalence of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer and describe characteristics and qualitative aspects of financial stressors in this population. Methods: Women diagnosed with advanced/recurrent endometrial cancer at an urban academic center were invited to participate in a mixed-methods study to describe quality-of-life (QOL) and financial toxicity. Participants completed surveys including the EuroQOL-5D-5 (QOL), financial toxicity tool (COmprehensive Score for Financial Toxicity (COST)) and completed an interview inquiring about financial stressors. Descriptive statistics were performed, and interviews were transcribed and analyzed using Atlas.ti to identify themes. Results: Eighty-four women participated in the study reflecting a 90% response rate. Participants were a median age of 67.0 years and 6 (7%) self-identified as Hispanic. Most participants self-identified as White (41, 49%), followed by Black (35, 42%), and multiracial (8, 10%). Forty (49%) participants had advanced stage cancer while 42 (52%) had recurrent cancer, with endometrioid adenocarcinoma (41,50%) represented as the most common histology followed by serous carcinoma (18, 22%), carcinosarcoma (11, 13%), the remaining clear cell carcinoma/mixed/undifferentiated (14, 17%). The median financial toxicity score of the population was 28.0 (IQR: 21-35) out of 44.0, with 38.1% of participants reporting moderate financial toxicity (COST &amp;lt;26) and 8.3% reporting severe financial toxicity (COST &amp;lt;14). Lower financial toxicity scores (indicating poor financial wellness) were associated with younger age (&amp;lt;65yo: 24.0 vs. &amp;gt;65yo: 32.0; p&amp;lt;0.01), Black and multiracial participants compared to white participants (Black: 26.0, multiracial: 16.5, white: 33.0; p&amp;lt;0.05), Hispanic ethnicity (13.5 vs. 30.0; p&amp;lt;0.001), single marital status (26.0 vs. 33.0; p&amp;lt;0.05), and lower education (Less than college: 24.1 vs. college and above: 30.0; p&amp;lt;0.05). On multivariate linear regression, financial toxicity scores were associated positively with older age (B= 6.5, p&amp;lt;0.01) and non-single marital status (B=4.8, p&amp;lt;0.05) but were negatively associated with Hispanic ethnicity (B= -11.4, p&amp;lt;0.05). The median QOL score (health utility score) of the population was 0.80 (IQR: 0.71- 0.85) and this score was positively correlated with better financial wellness (higher financial toxicity score) (R= 0.3, p&amp;lt;0.05). Qualitative analysis of participant interviews found that participants experiencing financial toxicity reported themes of “forced retirement” and “forced work interruptions” (9, 11%) while those with financial wellness praised “quality insurance coverage” (19, 23%). Conclusion: Patients with advanced/recurrent endometrial cancer experience a high rate of financial toxicity. Although limited by sample size, financial toxicity was found to be significantly worse in younger, single, and Hispanic women. Further work to study this at-needs population should be done to identify causes and develop solutions to assist patients with financial stressors. Citation Format: Sarah A. Ackroyd, Gini Fleming, Nada Attia, Cheska Zoleta, Nita K. Lee. The cause behind the COST – exploring qualitative and quantitative aspects of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A005.

Financial Toxicity and Health-Related Quality of Life Among Cancer Patients: A Correlational Study

Introduction: Financial toxicity can increase healthcare costs, in addition to negatively impacting the therapeutic adherence and health- related quality of life of cancer patients within the public healthcare system. Objective: To correlate financial toxicity with the adults living with cancer health-related quality of life during the COVID-19 pandemic. Materials and Methods: This is an observational, cross-sectional, correlational study conducted with 179 patients receiving care from the Unified Health System in a capital city in southern Brazil. Data collection was performed from September 2021 to December 2022, using questionnaires containing sociodemographic and clinical data, and the Comprehensive Score for Financial Toxicity and the Functional Assessment of Cancer Therapy-General. The correlation between financial toxicity and health-related quality of life was assessed using Spearman’s correlation coefficient at a 5 % significance level. Results: The correlation between financial toxicity and health-related quality of life was 0.41 (p-value &lt; 0.001). The financial toxicity and health-related quality of life scores were 20.1/44 and 73.3/108, respectively. Conclusion: This study has found that the lower the financial toxicity, the better the patients’ health-related quality of life. In this sense, recognizing the presence of financial toxicity in the treatment course could help improve adherence to treatment and health-related quality of life.

Supportive care needs and associated factors among caregivers of patients with colorectal cancer: a cross-sectional study

To assess the level of supportive care needs of caregivers of colorectal cancer patients and explore the related key influencing factors. Totaling 283 caregivers of patients with colorectal cancer were investigated in this study. Firstly, caregivers were invited to complete a set of questionnaires, including the general information questionnaire, the Supportive Care Needs Survey-Partners and the Caregivers of cancer patients, the Caregiver Preparedness Scale, the Benefit Finding Scale, and the Comprehensive Score for Financial Toxicity. Univariate and multivariate linear regression were performed to investigate the associated factors of supportive care needs. The caregivers of patients with colorectal cancer have a moderate level of needs, scored at 2.71 ± 0.42. Caregiver preparedness, benefit finding, and financial toxicity were significantly negatively associated with the supportive care needs of caregivers (r = − 0.555, P < 0.001; r = − 0.534, P < 0.001; and r = − 0.615, P < 0.001, respectively). Our multivariate regression analysis identified some factors that directly affected the supportive care needs of caregivers, including the duration of illness, tumor stage, the age and educational level of caregivers, caregiver preparedness, benefit finding, and financial toxicity (R2 = 0.574, F = 23.337, P < 0.001). Supportive care needs are common among caregivers of colorectal cancer patients. Higher caregiver preparedness, benefit finding, and financial toxicity tend to ease these needs. Healthcare workers should have an in-depth understanding of the needs of caregivers of colorectal cancer patients and actively provide targeted financial/informational/technical/emotional support to promote nursing skills and reduce caregivers’ burdens.

Financial toxicity and patient experience associated with financial burden of molecular-targeted and immune therapies for cancer: an observational study under public health insurance

BackgroundFinancial burden of cancer treatment can negatively affect patients and their families. This study aimed to evaluate the financial toxicity of patients treated with molecular-targeted and immune therapies and explore the relationship between financial toxicity and patient experiences associated with the financial burden of cancer treatment.MethodsThis anonymous, self-administered questionnaire survey conducted across nine hospitals in Japan included patients aged 20–60 years who were receiving molecular-targeted agents or immune checkpoint inhibitors for any type of cancer for ≥ 2 months. Financial toxicity was evaluated using the COmprehensive Score for Financial Toxicity (COST). Patient experience was examined using 11 items based on previous studies. Independent factors related to financial toxicity were explored using multiple regression analyses.ResultsThe mean COST score was 17.0 ± 8.4, and 68 (49.3%) participants reported COST scores at or below the cutoff point. The factors contributing to financial toxicity were “hesitation regarding continuing treatment based on finances” (sβ = − 0.410, p < 0.001), “cutting through my deposits and savings” (sβ = − 0.253, p = 0.003), and “reducing spending on basics like food or clothing” (sβ = − 0.205, p = 0.046) along with comorbidities (sβ = − 0.156, p = 0.032).ConclusionPatients receiving molecular-targeted and immune therapies are at risk of experiencing profound financial toxicity and a reduced quality of life. The independently related factors that we identified have the potential to serve as indicators of profound financial toxicity and the need for specialized intervention.

Financial toxicity in gynecologic oncology: a multi-practice survey

BackgroundFinancial toxicity is associated with worse cancer outcomes, including lower survival.ObjectiveTo characterize the prevalence of, and patient risk factors for, financial toxicity among gynecologic oncology patients in a multi-site health...

A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice

Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.

Financial toxicity among people with metastatic cancer: findings from the Cancer Experience Registry.

This study describes financial toxicity (FT) reported by people with metastatic cancer, characteristics associated with FT, and associations between FT and compensatory strategies to offset costs. Cancer Support Community's Cancer Experience Registry data was used to identify respondents with a solid tumor metastatic cancer who completed the Functional Assessment of Chronic Illness Therapy COmprehensive Score for Financial Toxicity (FACIT-COST) measure. Multivariable logistic regression analyses examined associations between respondent characteristics and FT, and FT and postponing medical visits, nonadherence to medications, and postponing supportive and/or psychosocial care. 484 individuals were included in the analysis; the most common cancers included metastatic breast (31%), lung (13%), gynecologic (10%), and colorectal (9%). Approximately half of participants (50.2%) reported some degree of FT. Those who were non-Hispanic White, Hispanic, or multiple races (compared to non-Hispanic Black), and who reported lower income, less education, and being less than one year since their cancer diagnosis had greater odds of reporting FT. Individuals with any level of FT were also more likely to report postponing medical visits (Adjusted Odds Ratio [OR] 2.58; 95% Confidence Interval [CI] 1.45-4.58), suboptimal medication adherence (Adjusted OR 5.05; 95% CI 2.77-9.20) and postponing supportive care and/or psychosocial support services (Adjusted OR 4.16; 95% CI 2.53-6.85) compared to those without FT. With increases in the number of people living longer with metastatic cancer and the rising costs of therapy, there will continue to be a need to systematically screen and intervene to prevent and mitigate FT for these survivors.

Determination of a cut-off COmprehensive Score for financial Toxicity (COST) for identifying cost-related treatment nonadherence and impaired health-related quality of life among Chinese patients with cancer

PurposeThis study aimed to determine a cut-off for the simplified Chinese version of the COmprehensive Score for financial Toxicity (COST) that could identify cost-related treatment nonadherence among Chinese patients with cancer. The study also sought to validate this cut-off score by using it to assess impaired health-related quality of life (HRQoL) in the same population.MethodsA secondary analysis was conducted using data from a cross-sectional survey of 1208 Chinese patients with cancer who were recruited from 12 hospitals in six cities across three provinces of the Chinese mainland. Sociodemographic information and data on financial toxicity (FT), cost-related treatment nonadherence, and HRQoL were used in the analysis. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off for the simplified Chinese version of the COST.ResultsThe ROC analysis identified a COST cut-off of 18.5 for identifying cost-related treatment nonadherence, yielding a sensitivity of 76.5% and specificity of 71.4%. In the validation study, this cut-off score yielded a sensitivity of 64.2% and a specificity of 67.1% for identifying impaired HRQoL.ConclusionEarly and dynamic assessment of cancer-related FT in routine clinical practice may play a crucial role in the early identification and management of FT. Accordingly, a COST cut-off of 18.5 was identified to indicate cost-related treatment nonadherence and impaired HRQoL in a population of patients with cancer from the Chinese mainland. This finding may facilitate the implementation of universal FT screening among patients with cancer in specific settings such as the Chinese mainland.

Patient-Reported Financial Burden of Treatment for Colon or Rectal Cancer

The longitudinal experience of patients is critical to the development of interventions to identify and reduce financial hardship. To evaluate financial hardship over 12 months in patients with newly diagnosed colorectal cancer (CRC) undergoing curative-intent therapy. This prospective, longitudinal cohort study was conducted between May 2018 and July 2020, with time points over 12 months. Participants included patients at National Cance Institute Community Oncology Research Program sites. Eligibility criteria included age at least 18 years, newly diagnosed stage I to III CRC, not started chemotherapy and/or radiation, treated with curative intent, and able to speak English. Data were analyzed from December 2022 through April 2023. The primary end point was financial hardship, measured using the Comprehensive Score for Financial Toxicity (COST), which assesses the psychological domain of financial hardship (range, 0-44; higher score indicates better financial well-being). Participants completed 30-minute surveys (online or paper) at baseline and 3, 6, and 12 months. A total of 450 participants (mean [SD] age, 61.0 [12.0] years; 240 [53.3%] male) completed the baseline survey; 33 participants (7.3%) were Black and 379 participants (84.2%) were White, and 14 participants (3.1%) identified as Hispanic or Latino and 424 participants (94.2%) identified as neither Hispanic nor Latino. There were 192 participants (42.7%) with an annual household income of $60 000 or greater. There was an improvement in financial hardship from diagnosis to 12 months of 0.3 (95% CI, 0.2 to 0.3) points per month (P < .001). Patients with better quality of life and greater self-efficacy had less financial toxicity. Each 1-unit increase in Functional Assessment of Cancer Therapy-General (rapid version) score was associated with an increase of 0.7 (95% CI, 0.5 to 0.9) points in COST score (P < .001); each 1-unit increase in self-efficacy associated with an increase of 0.6 (95% CI, 0.2 to 1.0) points in COST score (P = .006). Patients who lived in areas with lower neighborhood socioeconomic status had greater financial toxicity. Neighborhood deprivation index was associated with a decrease of 0.3 (95% CI, -0.5 to -0.1) points in COST score (P = .009). These findings suggest that interventions for financial toxicity in cancer care should focus on counseling to improve self-efficacy and mitigate financial worry and screening for these interventions should include patients at higher risk of financial burden.

Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis.

There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

A Brief Screening Tool for Assessment of Financial Toxicity.

To explore the utility of brief financial screening items to facilitate the implementation of routine financial toxicity screening. 50 women with breast cancer completed a one-time survey that included the Comprehensive Score for Financial Toxicity (COST): A FACIT Measure of Financial Toxicity, a visual analog scale, and a brief sociodemographic questionnaire. Survey responses were examined to assess the psychometric properties of individual COST items and the visual analog scale by calculating Cronbach's alpha and Pearson's correlation coefficients. The mean COST was 21.4, and 27 respondents met criteria for financial toxicity (a COST lower than 22). As expected, all items correlated strongly to the overall COST, but four items (items 3, 6, 8, and 10) performed strongest (r > 0.8). This study provides evidence for individual COST items to be used as brief screening items. Future research should test the utility of these items in larger sample sizes with a more diverse representation of patients by age, race, ethnicity, and tumor type and stage.

Assessing the financial impact of cancer drug list (CDL) implementation on patients receiving chemotherapy in an ambulatory cancer centre in Singapore

Background On 1st September 2022, the Cancer Drug List (CDL) was implemented to ensure the long-term affordability of chemotherapy and insurance premiums. This project aimed to determine the financial impact of CDL on out-of-pocket expenses (OOPE), acceptability and financial toxicity (FT) after CDL implementation. Methods A cross-sectional study was conducted at National Cancer Center Singapore. We analyzed OOPE before and after implementation of CDL by reviewing billing transactions in Aug-Sept 2022. Acceptability and FT were determined using theoretical framework of acceptability (TFA) and COmprehensive Score for financial Toxicity (COST) tool respectively via survey. Results Of the 314 patients finalized bills examined, majority (68.8%) experienced no change in their OOPE, and 69.1% had no OOPE. Most patients (72.6%) were unaware of implementation of CDL. Among patients aware of CDL, majority (61.9%) were accepting, but unsure on how it benefits them. FT was reported as low (mean COST score = 22.4 ± 9.9), and patients ≥65 years old or have at least pre-university education were less likely to experience FT. Conclusion Despite best efforts from policymakers, it is challenging to achieve a one-size fits funding or subsidy framework that can cater to the needs of all patients. Some groups of patients would inevitably still experience high OOPE and FT due to their personal or clinical circumstances. Patients can be better empowered to seek financial assistance or resources.

Health insurance as a moderator in the relationship between financial toxicity and medical cost-coping behaviors: Evidence from patients with lung cancer in China.

This study investigates the relationship between financial toxicity and medical cost-coping behaviors (MCCB) in Chinese patients with lung cancer, with a particular focus on the moderating role of health insurance. We surveyed 218 patients with lung cancer and assessed their Comprehensive Score for Financial Toxicity (COST) and self-reported MCCB. Patients were categorized into Urban Employee's Basic Medical Insurance (UEBMI) group and Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) groups by their medical insurance, and matched for socioeconomic, demographic, and disease characteristics via propensity score. Significant different characteristics were noted between UEBMI patients and URRBMI patients. Patients with UEBMI had higher COST scores but lower levels of MCCB compared to URRBMI patients in the original dataset. After data matching, multivariate logit regression analysis showed that better financial toxicity was associated with lower levels of MCCB (OR = 0.95, 95% CI: 0.92-0.99). Health insurance type did not have a direct association with cost-coping behaviors, but an interaction was observed between health insurance type and financial toxicity. Among patients with URRBMI, better financial toxicity was associated with lower levels of cost-coping behaviors (OR = 0.89, 95% CI: 0.83-0.95). Patients with UEBMI had a lower probability of engaging in any cost-coping behaviors insituations of worse financial toxicity compared to patients with URRBMI. The findings suggest that financial toxicity is correlated with MCCB in Chinese patients with lung cancer. The type of health insurance, specifically UEBMI and URRBMI, plays a moderating role in this relationship. Understanding these dynamics is essential for developing targeted interventions and policies to mitigate financial toxicity and improve patients' management of medical costs.