Posted: Wednesday, July 3, 2024
The Comprehensive Score for Financial Toxicity (COST) has grown in popularity for measuring the financial toxicity experienced by patients with cancer—but is this instrument as reliable as it should be? In their sequential mixed-methods study, which focused on 72 patients with multiple myeloma as a sample and was reported in JCO Oncology Practice, Mark A. Fiala, PhD, MSW, of Washington University School of Medicine, St. Louis, and colleagues found the answer is far from a clear “yes.” Given the inconsistencies in the results of their study, however, the 11-item instrument requires further research before it can be used as a consensus measure of financial toxicity.
During the study’s quantitative phase, the team collected COST scores at two time points approximately 8 weeks apart. In fact, 97% of participants changed their response to one or more item in the second assessment. “Only 13% of the sample had the same COST scores at both assessments; 38% had an improved score, and 50% had a worsened score,” noted the team.
In particular, item FT9, I am concerned about keeping my job and income, including work at home, was inconsistently reported. A total of 22% skipped the item on at least one assessment.
After receiving the second set of responses, Dr. Fiala and co-investigators initiated the study’s qualitative phase, conducting semistructured telephone interviews with the 12 patients whose scores had varied the most from the first to the second assessment. “Interestingly, 5 of the 12…did not report any changes to their status that would have corresponded with changes to the COST score,” noted the authors. “It is possible that these patients had meaningful changes to their subjective financial distress that was difficult for them to vocalize or not addressed by the interview questions.”
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
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