New tool predicts financial toxicity for cancer patients

Cancer care has a new side effect. The expense, anxiety, and distress confronting patients faced with large, unpredictable costs from their cancer treatment have been dubbed financial toxicity.

A new tool that measures a patient's risk for and ability to cope with financial stress is described in an article in Cancer (2014; doi:10.1002/cncr.28814). The patient-reported outcome measure is aptly named COST (Comprehensive Score for financial Toxicity).

"Few physicians discuss this side effect with their patients," said study author Jonas de Souza, MD, a head-and-neck cancer specialist at the University of Chicago School of Medicine, Chicago, Illinois. "This new tool to help predict a patient's risk for financial stress may open the lines of communication. This gives us a way to launch the discussion."

The cost of health care in the United States is rising faster than the gross domestic product. In addition, the cost of cancer care, especially the cost of new cancer drugs, is rising dramatically. Annual medical expenditures increased by more than $4,000 for men and by nearly $3,300 for women who have had cancer.  

Financial pain may extend beyond treatment. A recent study from the Centers for Disease Control and Prevention (CDC) found that 30% of cancer survivors were not able to return to work, or had a decreased ability to work.

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

Development of the COST questionnaire began with a literature review and extensive interviews with patients, cancer professionals, nurses, and social workers. This study produced a set of 11 statements.

Each statement is short and easy to understand. For example, item 2 states: “My out-of-pocket medical expenses are more than I thought they would be.” Item 7 states: “I am able to meet my monthly expenses.”

Patients choose from five responses: not at all, a little bit, somewhat, quite a bit, or very much. A patient's responses may help caregivers determine who needs education, financial counseling, or referral to a support network.

All patients who participated in the study had been in treatment for at least 2 months and had received bills. Patients in the study earned between $37,000 and $111,000 (the top 10% and bottom 10% of earners were excluded). The median annual income for these patients was about $63,000.

The researchers found that financial toxicity did not correlate with income. "People with less education seemed to have more financial distress, but variations in income did not make much difference. We need larger studies to confirm that, but at least we now have a tool we can use to study this," said de Souza.

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