Oncologists may have a new tool to help measure a patient’s risk for financial stress and financial toxicity, which is an increasingly significant problem that comes along with many new cancer therapies.

Researchers at The University of Chicago have now developed a patient-reported outcome measure called COST (COmprehensive Score for Financial Toxicity) and they hope it will give clinicians a better idea of which patients may need education, financial counseling, or referral to a support network. The researchers also hope this new tool will help oncologists more accurately predict which patients are likely to have problems with their finances and will require interventions.

“We have been talking about financial toxicity for the past 2 years, but we have not seen how it affects outcomes,” said study author Jonas de Souza, MD, a head-and-neck cancer specialist at The University of Chicago School of Medicine in Chicago, IL. “We can better manage patients in the future with a measure like this. The costs may change their decision about the treatment.”

A Tool for Oncologists to Evaluate Financial Burden on Patients

Dr. de Souza said that currently few physicians discuss financial issues with their patients because they have historically not been adequately trained for handling the financial aspects of oncology care. He said, oftentimes, discussing financial issues can make the clinician and patient uncomfortable. Dr. de Souza and his colleagues reported in the July 2014 issue of the journal Cancer that there is no patient-reported outcome measure (PROM) currently available that specifically describes the financial distress experienced by patients with cancer.1

Yet it is well known in the oncology community that higher patient costs and copayments are associated with decreased treatment compliance. Researchers at Duke University conducted a study with 254 patients with cancer and found that 42% suffered a significant or catastrophic subjective financial burden and 20% took less than the prescribed amount of medication.2 This study also found that 19% of prescriptions for cancer drugs were partially filled and 24% of patients avoided filling prescriptions altogether to save money.

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“We are trying to figure out what is happening and what can be done to intervene. We need to figure out how best to talk about costs with patients,” Dr. de Souza noted in an interview with CancerTherapyAdvisor.com. “We don’t know if we should discuss costs if it may make [the patient] more anxious, and it may just be adding anxiety for the patient when there is nothing that can be done. We need to study it more.”

The COST questionnaire was developed through a series of extensive interviews with 155 patients with advanced cancer, as well as oncologists, nurses, and social workers. A total of 147 questions were derived from the interviews, and then the list was consolidated to just 30 questions following patient surveys. In its current form, the questionnaire includes a set of 11 statements (Download a PDF version of the questionnaire). 

Dr. de Souza explained that how patients respond to the 11 statements may better identify which ones may need tailored treatment plans to avoid financial toxicity. He hopes that this tool can improve shared decision-making between patients and physicians, and believes it may also aid in the drug development process, as the tool has the potential to measure the effect of the cost of new therapies for patients in real-life scenarios. 

All the patients who helped develop the 11 statements had been in cancer treatment for at least 2 months and had received bills for their treatment. The median annual income was $63,000 (range: $37,000 to $111,000). The researchers expected that financial toxicity would correlate with income; however, that was not the case. They found that less education was associated with greater risk for financial distress but variations in income did not make a difference.

“Most of the patients were in a very small range of income and so we need to look at more patients and those with smaller incomes,” explained Dr. de Souza. He and his colleagues are now conducting a larger study to validate these findings and correlate the scores from the COST questionnaire with quality of life and anxiety in patients with cancer.