Development and Validation of a Simplified Financial Toxicity Screening Tool for Use in Clinical Practice

Area of Science:

• Oncology
• Health Services Research
• Health Economics

Background:

• Cancer-related financial toxicity is prevalent and contributes to healthcare inequities.
• Current screening methods for financial toxicity lack consistency and integration into clinical workflows.
• A validated tool is needed to efficiently identify patients experiencing financial toxicity.

Purpose of the Study:

• To develop and validate an abbreviated version of the Comprehensive Score for Financial Toxicity (COST) tool.
• To create a brief screening measure suitable for integration into clinical settings.
• To assess the predictive value of a two-item COST tool against the full research-based measure.

Main Methods:

• A quality improvement project utilized 57,526 longitudinal COST surveys from 38,249 cancer patients.
• An iterative algorithm identified the two items most correlated with the full COST score.
• Positive and negative predictive values (PPV, NPV) of the two-item scale were assessed against the full COST score.

Main Results:

• The two-item abbreviated COST tool (using questions on future financial worries and current satisfaction) showed a high correlation (0.922) with the full COST score.
• The abbreviated tool demonstrated strong predictive values: PPV ranged from 74% to 91%, and NPV ranged from 91% to 98%.

Conclusions:

• A simplified two-question COST tool exhibits high predictive accuracy compared to the full validated measure.
• This abbreviated COST measure is appropriate for implementation in clinical screening workflows.
• The validated abbreviated tool can aid in identifying and addressing financial toxicity in cancer patients.