The validation of the Italian version of the COmprehensive Score for financial Toxicity (COST)
- 38 Downloads
Financial toxicity (FT) is the unintended, potential economic harm or damage of oncologic treatments that has become a medical problem with political implications. To assess FT, the COmprehensive Score for financial Toxicity (COST) questionnaire was developed. Since an Italian version is not available yet, we aimed to validate the Italian version of the COST questionnaire in a population of cancer patients during oncologic treatments or follow-up.
A sample of Italian native outpatients were asked to fill the Italian version of the COST and five other self-administered questionnaires to assess quality of life, treatment-related symptoms, hope, distress, and unmet needs. Additionally, a subsample of patients was asked to retake the COST after 2–6 weeks.
A single factor better represents the scale structure. Internal consistency and test–retest reliability were good. Evidence of convergent and discriminant validity was provided and criterion validity was established, showing that financial toxicity predicts the patient’s distress. Finally, known-groups validity was confirmed, testing the differences related to treatment-related expenses, sociodemographic characteristics, stage of the disease, and performance status.
The current findings suggest the Italian version of the COST is a psychometrically sound scale that potentially offers an added value in assessing FT in patients with cancer.
KeywordsToxicity Financial burden Oncologic treatments Cancer patients Distress Psychometric validation
We would like to thank Barbara Bachtiary, MD, MSc, Paul Scherrer Institute Center for Proton Therapy, Switzerland; and Emily Parks-Vernizzi, MFA; Jason Bredle, MFA; and Benjamin J. Arnold, MA, FACIT.org, Ponte Vedra, FL, for their contribution in producing the Italian version of the COST.
All authors contributed to the study conception and design. Patients’ recruitment, material preparation, and data collection were performed by Carla Ida Ripamonti, Patricia Di Pede, Mauro Guglielmo, Luisa Toffolatti, and Laura Gangeri. Data analysis and interpretation of results were performed by Francesca Chiesi. The first draft of the manuscript was written by Carla Ida Ripamonti, Francesca Chiesi, and Elena Allocca, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethic Committee of Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy, protocol number: INT 41/19) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- 1.Zafar SY, Abernethy AP (2013) Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park) 27(2):80–84Google Scholar
- 6.Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D (2016) Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34:1732–1740. https://doi.org/10.1200/JCO.2015.63.2232 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Neugut AI, Subar M, Wilde ET, Stratton S, Brouse CH, Hillyer GC, Grann VR, Hershman DL (2011) Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29:2534–2542. https://doi.org/10.1200/JCO.2010.33.3179 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, Nicholas LH, O'Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D (2017) Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 123:476–484. https://doi.org/10.1002/cncr.30369 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Chiesi F, Bonacchi A, Primi C, Miccinesi G (2017) Assessing unmet needs in patients with cancer: an investigation of differential item functioning of the Needs Evaluation Questionnaire across gender, age and phase of the disease. PLoS One 12:1–12. https://doi.org/10.1371/journal.pone.0179765 CrossRefGoogle Scholar
- 21.Ripamonti CI, Buonaccorso L, Maruelli A et al Hope Herth Index (HHI): a validation study in Italian patients with solid and hematological malignancies on active cancer treatment. Tumori 98:385–392. https://doi.org/10.1700/1125.12409
- 24.Chochinov HM, Hassard T, McClement S, Hack T, Kristjanson LJ, Harlos M, Sinclair S, Murray A (2008) The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care. J Pain Symptom Manag 36:559–571. https://doi.org/10.1016/j.jpainsymman.2007.12.018 CrossRefGoogle Scholar
- 25.Ripamonti CI, Buonaccorso L, Maruelli A et al Patient dignity inventory (PDI) questionnaire: the validation study in Italian patients with solid and hematological cancers on active oncological treatments. Tumori 98:491–500. https://doi.org/10.1700/1146.12645
- 26.Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Eval Chemother Agents. Columbia Univ Press, New York, p 196Google Scholar
- 30.Muthen B, Kaplan D (1992) A comparison of some methodologies for the factor analysis of non-normal Likert variables: a note on the size of the model. Br J Math Stat Psychol 45:19–30. https://doi.org/10.1111/j.2044-8317.1992.tb00975.x CrossRefGoogle Scholar