Screening tool identifies people with cancer at risk for financial toxicity
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Researchers at Columbia School of Nursing developed and evaluated a brief tool for predicting financial toxicity among patients with breast cancer.
In the study, published in Oncology Nursing Forum, the researchers evaluated the psychometric value of Comprehensive Score for Financial Toxicity (COST) — an 11-item questionnaire — as well as a visual analog scale and brief sociodemographic questionnaire for 50 women with breast cancer.
“Our study adds to the literature to support that, when looking at the 11-item COST, all items could potentially be considered for screening implementation because of how strongly they perform psychometrically,” Melissa P. Beauchemin, PhD, MSN, CPNP-PC, CPON, assistant professor of nursing at Columbia School of Nursing, told Healio. “However, our study also suggests that four items may be strongest and warrant consideration.”
Healio spoke with Beauchemin about the importance of identifying “rising risk” for financial toxicity, the need for brevity in a screening tool, and how she hopes this tool will help patients navigate the financial burdens of cancer care.
Healio: What motivated you to develop this tool?
Beauchemin: The concept behind this originated from a parent study funded by an NCI P30 supplement. The parent study focused on implementing systematic financial screening starting in our outpatient breast oncology clinic. This initiative is aligned with recommendations from ASCO and other organizations, which endorse screening every person with cancer for financial hardship, burden and toxicity. The terminology around financial hardship can be complicated so, within that implementation study, we aimed to investigate the utility of a brief screening tool.
Healio: How did you develop the tool?
Beauchemin: We looked at COST, an 11-item measure developed and published in 2014 by de Souza and colleagues. The idea for this brief tool originated from discussions with clinicians, clinic administrators and patients about what would be feasible within a busy outpatient oncology clinic for identifying those at risk for financial toxicity.
Healio: What four items from the COST questionnaire most predicted financial toxicity?
Beauchemin: The four items that performed best were “I worry about the financial problems I will have in the future as a result of my illness or treatment,” “I’m satisfied with my current financial situation,” “I feel financially stressed,” and “My cancer or treatment has reduced my satisfaction with my present financial situation.” These statements are all getting at that financial stress, which is a key component of financial toxicity.
Healio: How did you evaluate the tool?
Beauchemin: We implemented this tool in clinic in 2021, and when we evaluated the brief tool, we found that about 50% of our patients screened positive for financial toxicity. When we looked at the full 11-item validated instrument, we similarly found that about 50% screened positive. So, we think that it’s fairly accurate for identifying patients who are experiencing toxicity. This tool is intended as a screener, knowing that the next step is to follow up and evaluate more thoroughly what the financial toxicity concerns are at the individual level.
Healio: Is this tool available for public use?
Beauchemin: It is published and available, and it’s easy to implement. We’ve built it into our EPIC electronic health record system.
Healio: Why is it important to screen patients and quickly identify those at risk for financial toxicity?
Beauchemin: Screening helps us to not only identify people with financial toxicity, but also identify rising risk for future financial toxicity. The way we’ve utilized this in our clinical setting has enabled us to identify patients who might be eligible for interventions such as financial navigation or other novel interventions aimed at addressing health-related social needs. We’re optimistic that this is going to improve our ability to identify people who can potentially benefit from these types of interventions.
Healio: Is there anything else you’d like to mention?
Beauchemin: It’s concerning to know that over 50% of patients in our study experienced some level of financial toxicity during cancer treatment. In certain groups of patients, the number is often even higher. Just knowing the prevalence of this underscores the importance of normalizing conversations about financial toxicity, identifying it more accurately and doing more about it. That is the key problem the oncology community needs to address — to develop interventions and influence policy changes that support patients through their cancer treatment.
References:
- Beauchemin M, et al. Oncol Nurs Forum. 2024;doi:10.1188/24.ONF.17-23.
- Beauchemin M, et al. JCO Clin Cancer Inform. 2023;doi:10.1200/CCI.22.00172.PMID:36944141.
- de Souza JA, et al. Cancer. 2014;doi:10.1002/cncr.28814.
For more information:
Melissa P. Beauchemin, PhD, MSN, CPNP-PC, CPON, can be reached at Columbia University Irving Medical Center/Herbert Irving Pavilion, 161 Fort Washington Ave. #527, New York, NY 10032; email: mmp2123@cumc.columbia.edu.
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