Source: Myeloma – Hematology Advisor
The use of the Comprehensive Score for Financial Toxicity (COST) as a tool to standardize the measurement of financial toxicity among patients with cancer is increasing, but whether changes in COST score overtime is meaningful is not yet clear.
“For some patients, changes in COST score may be spurious and not rooted in meaningful changes in financial toxicity status,” the authors wrote in their report published in JCO Oncology Practice.
The study used a sequential mixed-methods approach, in which COST scores at 2 time points were collected 8 weeks apart from 72 patients with multiple myeloma (MM) as part of a quantitative assessment. Then a qualitative assessment was conducted with a subset of 12 patients with the largest change in COST scores, who participated in semistructured interviews.
The majority of patients demonstrated a change in COST score, with 38% demonstrating an improved score and 50% a worse score. The absolute change was a median of 4 points, with the first assessment demonstrating a median score of 25 and the second assessment a median of 22.5.
Intrapatient agreement was 50%. In addition, the majority of patients did not complete all items on the COST instrument at both assessments (3%).
Among the interviewed patients, 58% reported a change to at least 1 of the constructs of the financial toxicity conceptual model. Out-of-pocket medical costs were the most common change, occurring in 42% of cases, followed by nonmedical expenses in 17% and subjective financial burden in 17%.
Increases in out-of-pocket medical costs were the result of loss or reduction of financial assistance, a change in treatment, and increase in clinic visits. Decreases were a result of an increase in financial assistance and reduced frequency of treatment.
The authors identified areas where additional research regarding the use of the COST score is needed, including determining a meaningful cutoff for financial toxicity and that the instrument focuses on subjective questions.