Cancer specialists from the University of Chicago, IL, have developed an innovative new tool to measure a cancer patient's risk for - and ability to tolerate - financial stress. They publish details of the COST (COmprehensive Score for financial Toxicity) tool - the first of its kind - in the journal Cancer.
Currently, in the US, the cost of health care is rising faster than gross domestic product, the cost of cancer care is rising faster than the cost of health care, and the cost of new cancer drugs is rising faster than the overall cost of cancer care.
And it is not just cancer patients undergoing treatment who are prone to financial hardship. The Centers for Disease Control and Prevention (CDC) recently found that 30% of cancer survivors are unable to return to work or have decreased working ability.
Men who have had cancer can expect an annual medical expenditure increase of more than $4,000, with an annual increase of $3,300 for female cancer survivors.
Study author Dr. Jonas de Souza, a head-and-neck cancer specialist at the University of Chicago Medicine, says that few doctors discuss the financial burden of cancer with their patients.
"Physicians aren't trained to do this," he says. "It makes them, as well as patients, feel uncomfortable. We aren't good at it. We believe that a thoughtful, concise tool that could help predict a patient's risk for financial toxicity might open the lines of communication. This gives us a way to launch that discussion."
If patients know what to expect, Dr. de Souza reasoned, then they may want their doctors to consider less costly medications. With that in mind, he and his colleagues decided that a new outcome measure is needed to assess which patients are at greatest financial risk.
Patients and oncologists worked together to create COST
After reviewing the available literature, Dr. de Souza and his team interviewed cancer patients, oncologists, nurses and social workers. From this research, the team were able to develop a set of finance-related statements that would form the basis of the assessment.
COST requires patients to choose one of five potential responses for each statement. The set responses are: not at all, a little bit, somewhat, quite a bit or very much.
The statements were designed to be short and easy to understand, for example: "My out-of-pocket medical expenses are more than I thought they would be."
"In the end, 155 patients led us, with some judicious editing, to a set of 11 statements," de Souza says. "This was sufficiently brief to prevent annoying those responding to the questions but thorough enough to get us the information we need."
The researchers anticipated a correlation between income and financial hardship, however that correlation did not appear within the small sample of 155 patients.
Instead, de Souza notes that "people with less education seemed to have more financial distress, but variations in income did not make much difference."
"We need bigger studies to confirm that," he adds, "but at least we now have a tool we can use to study this."
Next, the team will attempt to validate their findings by conducting a larger study that will correlate the new scale with quality of life and anxiety in cancer patients.
"We need to assess outcomes that are important for patients," de Souza concludes. "At the end, this is another important piece of information in the shared-decision-making process."