New Tool Calculates Cancer Patients’ Financial Toxicity

The Comprehensive Score for Financial Toxicity calculates a patient’s risk for financial distress due to the high cost of treatment.

Oncologists at the University of Chicago have developed a tool to measure patients’ risk for financial toxicity following cancer diagnosis and treatment.

The 11-part Comprehensive Score for Financial Toxicity (COST) assesses a patient’s risk for financial distress due to the high cost of treatment and subsequent economic challenges, such as loss of income. The tool, which is based on conversations with more than 150 patients with advanced cancer, is described in the July issue of Cancer.

“Few physicians discuss this increasingly significant side effect with their patients,” said head and neck cancer specialist and lead study author Jonas de Souza, MD, in a University of Chicago Medicine news release. “We believe that a thoughtful, concise tool that could help predict a patient's risk for financial toxicity might open the lines of communication” between patients and physicians.

Cancer survivors often have higher annual medical expenses-an increase of between $3,000 and $4,000 according to a government study-but lower income because they either cannot return to work or must reduce their hours, researchers said.

“We need better ways to find out which patients are most at risk,” said de Souza. “Then we can help them get financial assistance. If patients know what to expect, they may want their physicians to consider less costly medications.”

The COST tool asks patients to read 11 simple statements, such as “I feel financially stressed” or “I am frustrated that I cannot work or contribute as much as I usually do” and choose one of five responses: not at all, a little bit, somewhat, quite a bit, or very much. Patients’ responses may be able to help providers determine who would benefit from financial counseling, education, or referral to support networks.

In developing the tool, researchers conducted a literature review and worked extensively with groups of cancer patients to pare down an initial list of 147 questions to 11 in the final questionnaire. Patients ranged in age from 24 to 84 years, had a median household income of $63,500, and had been in treatment for at least 2 months-long enough to have received their first medical bill.

Researchers observed that patients of all income levels appear to be affected by financial distress. Patients with higher incomes may opt for expensive treatments that put them at risk for bankruptcy while those of lower socioeconomic status may decide to forgo care due to the high cost of treatments.

“Escalating cancer care costs raise the concern of increasing financial distress and further disparities in cancer care,” they wrote, “urging society, policy makers, and providers to measure this distress and identify patients at risk.”

The researchers are now conducting a larger study to validate the findings and explore whether the COST tool can help lower patients’ anxiety and improve their quality of life.

“We need to assess outcomes that are important for patients,” said de Souza. “This is another important piece of information in the shared decision-making process.”