June 20, 2014
New Tool Predicts The Painful ‘COST’ Of Cancer
Brett Smith for redOrbit.com - Your Universe Online
While cancer treatment is well-known for the physical and emotional stress it puts on a patient, a new study has revealed new details about the financial pain that treatment can inflict on a person.
Published in the journal Cancer, the new study resulted in the development of an 11-question tool called the COmprehensive Score for financial Toxicity (COST) that can accurately measure a patient's risk for, and capacity to withstand, financial stress.
"Few physicians discuss this increasingly significant side effect with their patients," said study author Dr. Jonas de Souza, a head-and-neck cancer specialist at the University of Chicago Medicine.
"Physicians aren't trained to do this. It makes them, as well as patients, feel uncomfortable," he added. "We aren't good at it. We believe that a thoughtful, concise tool that could help predict a patient's risk for financial toxicity might open the lines of communication. This gives us a way to launch that discussion."
The team developed the COST survey by starting with a literature review and a number of extensive in-person interviews. The researchers chatted with 20 patients and six cancer specialists, along with nurses and social workers. These initial conversations resulted in a list of 147 questions. The scientists then whittled the list down to 58 questions. Next, they asked 35 patients which of the remaining questions were the most critical to their situation, resulting in a 30-item list.
"In the end, 155 patients led us, with some judicious editing, to a set of 11 statements," de Souza said. "This was sufficiently brief to prevent annoying those responding to the questions but thorough enough to get us the information we need."
The researchers described their 11 questions as short and easy to understand. Questions included asking patients the degree with which they agreed with statements like, “My out-of-pocket medical expenses are more than I thought they would be” or “I am able to meet my monthly expenses.”
Patients who helped devise COST had been in therapy for at least sixty days and had obtained bills. Not including the top 10 percent and the bottom 10 percent, participants earned between $37,000 and $111,000. The median yearly income for these patients was approximately $63,000.
The researchers said they expected that financial toxicity would be connected with income.
"But in our small sample that did not hold up," de Souza said. "People with less education seemed to have more financial distress, but variations in income did not make much difference. We need bigger studies to confirm that, but at least we now have a tool we can use to study this."
The team said they are now expanding their study to confirm these findings and link the newly developed scale with quality of life and stress in cancer patients.
"We need to assess outcomes that are important for patients," de Souza said. "The cost burden cancer patients experience is definitely one. Measuring this toxicity is the first step towards addressing this important issue.”
"At the end," he added, "this is another important piece of information in the shared-decision-making process."