Financial Toxicity Survey in Patients With Gynecologic Cancer

To describe the sensitivity, specificity, and positive and negative predictive values of the COST (Comprehensive Score for Financial Toxicity) survey for predicting whether patients would report altering spending habits, borrowing money, not filling prescriptions, or experiencing an inability to afford groceries secondary to cancer care costs in a population of patients with gynecologic cancer.

This was a single-institution, cross-sectional study of patients with gynecologic cancer within 5 years of initial diagnosis or disease recurrence. Patients completed a one-time COST survey and were screened for altering spending habits, borrowing money, not filling prescriptions, or experiencing food insecurity.

A total of 323 patients consented and completed the survey; their mean age was 63 years, and 36.5% self-identified as Black. The mean COST score was 22. The COST score had an area under the curve value of 0.92 for predicting whether a patient would report altering spending habits, borrowing money, not filling prescriptions, or experiencing food insecurity. The cutoff COST score to maximize sensitivity and specificity was 26. At this cutoff, the score was 83.1% sensitive and 88.2% specific and had a positive predictive value of 92.9% and a negative predictive value of 73.7% for identifying those who would screen positive for reporting altering spending habits, borrowing money, delaying buying medications, or experiencing food insecurity.

Our data indicate that the COST score, a measure of financial toxicity, is associated with social determinants of health in patients with gynecologic cancer. The COST score may help to predict additional needs outside of financial assistance.