Assessing the reliability and validity of comprehensive score for financial toxicity (COST) among radiation oncology patients in India: a cross-sectional pilot study

Abstract

Background: Besides physical toxicity, cancer care imposes significant financial distress referred to as financial toxicity (FT). FT has become a growing concern among cancer patients. Researchers have associated FT among cancer patients with clinical outcomes like mortality, poor quality of life and non-adherence. Currently, no reliable tools are available for assessing FT among cancer patients in India. The aim of this pilot study was to test the reliability and validity of the Comprehensive Score for Financial Toxicity (COST) questionnaire among patients undergoing radiotherapy in India. Material and methods:This cross-sectional pilot study was conducted among head and neck cancer patients on follow-up in radiation oncology department. The reliability of COST measure was assessed using Cronbach's α. The underlying construct of COST was verified by Exploratory Factor Analysis (EFA). EFA was performed using parallel analysis technique.Results: Based on inclusion and exclusion criteria, the COST questionnaire was administered to 29 patients using the interview method after written informed consent. The COST measure demonstrated excellent reliability with Cronbach's α of 0.92. A Kaiser-Meyer-Olkin of 0.87 verified the sample adequacy and a p-value of ˂0.001on Bartlett's sphericity test indicated that the strength of the correlation between 11 COST items was good to perform the EFA. Parallel analysis technique identified one factor on scree plot with eigenvalue of 6.21 explaining 56.5% of the variance by non-rotated solution. All the factor loadings in one factor model were ˃0.3 (range 0.35-0.97). The factor loadings indicated that the underlying construct can be considered as one factor domain as intended by the original COST development study. However, Chi-square goodness of fit test revealed the one factor model did not adequately depict the data. However, the results were consistent with the construct obtained in the original scale development study. Conclusion:This pilot study demonstrated excellent reliability of COST for measuring FT among radiation oncology patients. Further studies are warranted to study the clinical implications of FT in the Indian population for making better strategies and policies to ease the financial burden on cancer patients.

Psychometric properties of self-reported financial toxicity measures in cancer survivors: a systematic review

“…After duplications were removed, a total of 11 731 articles were retained, 11 669 articles were deleted after reading the title and abstract, and 39 were deleted after full-text reading. Finally, a total of 23 articles (21 PROMs) were eligible for inclusion in this study 12 14 16 23–42…”

“…All included studies were published from 2005 to 2022. Eight studies were conducted in the USA,12 14 23 27 30 37 39 41 four in the UK,16 29 35 38 two in Canada31 36 and two in China (mainland and Hong Kong),25 39 India26 34 and Italy 33 42. One study was conducted in 12 countries in Europe and North America 22 23.…”

“…Among the 21 PROMs, 7 were FT-related domains of quality of life PROMs and 14 were independent PROMs focusing on FT. All PROMs were validated in cancer survivors. Fifteen PROMs were in English,12 14 16 23 25–31 35 37 38 40–42 and two were in Chinese 24 39. Other languages included French,36 Portuguese,32 Italian,33 42 Hindi25 26 and Persian 34.…”

“…Fifteen PROMs were in English,12 14 16 23 25–31 35 37 38 40–42 and two were in Chinese 24 39. Other languages included French,36 Portuguese,32 Italian,33 42 Hindi25 26 and Persian 34. The number of items evaluating FT ranged from 340 to 23 36.…”

Prevalence and risk factors of self-reported financial toxicity in cancer survivors: A systematic review and meta-analysis

“…Several instruments have been developed, validated, and intended for self-reported nancial toxicity in cancer patients: Breast Cancer Finances Survey Inventory(BCFS) [12][13] , Socioeconomic Wellbeing scale(SWS) 14 , the InCharge Financial Distress/Financial Well-Being Scale(InCharge/FWS) 15 , the Financial Distress Questionnaire(FDQ) 16 , Financial Index of Toxicity(FIT) 17 , and the Comprehensive Score for nancial Toxicity (COST) [18][19] . Among all measures, the COST tools was the most commonly used survey tools and was developed by de Souza 18 to meet the nancial toxicity investigations of cancer patients in the United States, which has been veri ed in many countries around the world, including China 20 , India 21 , Italy 22 , Australia 23 , Japan 24 , etc., and has achieved good reliability and validity.Based on differences in health related quality of life(HRQoL), analogous to the NCI-Common Terminology Criteria for Adverse Events, the COST-PROM grading system was developed by de Souza with 4 FT grades (G) 25 : Grade0, no FT, COST score ≥ 26 ; Grade1, mild FT:COST score ≥ 14-26; Grade2, moderate FT: score > 0-14; and Grade3, severe FT: COST score = 0.…”