Financial toxicity in patients with cancer attending a public Australian tertiary hospital: A pilot study

As therapeutic options for cancer evolve and become more complex, the concept of financial toxicity has emerged. The comprehensive score for financial toxicity (COST) and iMTA Productivity Cost questionnaires (iPCQ) represent two tools developed to measure the concept. The aim of this pilot study was to review the impact of financial toxicity in patients with cancer in an Australian public setting where there is a universal health care model.

This pilot study utilized an exploratory, cross-sectional design in a single Australian large inner-city tertiary center. After providing written consent eligible patients, in an ambulatory setting, completed four self-reporting questionnaires, which were written in English (basic demographics, COST, iPCQ and the European Organization Research Treatment of Cancer Quality of Life Questionnaire-C30 [EORTC-QLQ-C30]).

Of 97 patients approached, 66 consented to participate. The median age was 63.5 years. Fifty-five percent were female. Fifty-three completed COST questionnaires. The median score for financial toxicity was 18 (range 1-42). Higher COST scores indicated greater financial concerns and were associated with poorer quality of life (P = .004). This was maintained after adjusting for confounders (age, gender, regional postcode.) Univariate analysis demonstrated younger age was associated with higher COST scores (P < .001), while gender (P = .243) and geographical location (P = .243) were not.

In a cohort of patients receiving systemic cancer therapy in an Australian public setting, financial toxicity was associated with poorer quality of life. Despite a universal health-model, the COST questionnaire identified a substantial proportion of patients who experienced financial toxicity.