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Comparison of two validated instruments to measure financial hardship in cancer survivors: comprehensive score for financial toxicity (COST) versus personal financial wellness (PFW) scale

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Abstract

Purpose

Financial distress and financial toxicity are recognized challenges in cancer survivorship. Financial toxicity includes both objective measures of hardship and subjective distress. We hypothesized that subjective financial distress is correlated to overall holistic financial toxicity. We compared two widely accepted instruments to measure financial distress and financial toxicity.

Methods

Patients in the follow-up phase of care at a single institution were surveyed regarding demographic and economic status. Financial toxicity was measured using the comprehensive score for financial toxicity–functional assessment of chronic illness (COST-FACIT) and financial distress using the personal financial wellness (PFW) scale. Surveys were analyzed for correlation and internal consistency. Patient score distributions were compared. Associations between survey scores and patient factors were assessed using multivariable linear regression models.

Results

A total of 116 patients were included. Scores from the COST-FACIT showed a strong correlation with PFW scores (r = 0.90, p < 0.0001). Scale reliability was high for both the COST-FACIT (α = 0.92) and PFW (α = 0.97) surveys. Score distributions exhibited left skew for both surveys, with 9.5% of patient scores falling in the worst quartile of possible scores on each respective survey. The strongest predictors of financial distress and financial toxicity included young age, lower monetary savings, lower household income, and less perceived social support during cancer treatment.

Conclusions

The COST-FACIT measure of financial toxicity correlated strongly with PFW measure of financial distress. Although these instruments were designed to assess different concepts (financial distress vs financial toxicity), they gave strikingly similar results. Either instrument may be used as a meaningful patient-reported outcome for study of financial distress in cancer survivors. However, the COST-FACIT construct of financial toxicity does not appear to add additional information beyond financial distress.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Kevin A. D’Rummo

  2. The University of Kansas School of Medicine, Kansas City, KS, USA

    David Nganga

  3. Department of Biostatistics & Data Science, Medical Center, The University of Kansas, Kansas City, KS, USA

    Lynn Chollet-Hinton

  4. Department of Radiation Oncology, The University of Kansas Medical Center, 4001 Rainbow BlvdMailstop 4033, Kansas City, KS, 66160, USA

    Xinglei Shen

Authors
  1. Kevin A. D’Rummo
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  2. David Nganga
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  4. Xinglei Shen
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Contributions

Kevin A. D’Rummo: data curation, investigation, visualization, writing–original draft.

David Nganga: data curation, investigation.

Lynn Chollet-Hinton: formal analysis, visualization, writing–review and editing.

Xinglei Shen: conceptualization, investigation, methodology, supervision, writing–review and editing.

Corresponding author

Correspondence to Xinglei Shen.

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Ethics approval

This study was approved by the University of Kansas Medical Center Human Subjects Committee.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Supplementary Information

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Supplementary file1 (DOCX 29 KB)

520_2022_7455_MOESM2_ESM.pdf

Supplemental Figure 1 Distribution of (A) COST-FACIT scores and (B) PFW scores for the study population (N=116). COST-FACIT, Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy; PFW, Personal Financial Wellness scale. (PDF 379 KB)

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D’Rummo, K., Nganga, D., Chollet-Hinton, L. et al. Comparison of two validated instruments to measure financial hardship in cancer survivors: comprehensive score for financial toxicity (COST) versus personal financial wellness (PFW) scale. Support Care Cancer 31, 12 (2023). https://doi.org/10.1007/s00520-022-07455-y

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