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Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients

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Abstract

Purpose

To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT).

Methods

A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher’s exact, chi-squared or independent sample t-test.

Results

The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance.

Conclusion

Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention.

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Data availability

The data of the study will be available on request from the corresponding author (winnieso@cuhk.edu.hk).

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Funding

This study was funded by The Chinese University of Hong Kong (reference number: CA-1806).

Author information

Authors and Affiliations

  1. The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Marques S.N. Ng, Kai Chow Choi, Dorothy N.S. Chan, Cho Lee Wong & Winnie K.W. So

  2. School of Nursing, Fudan University, Shanghai, China

    Weijie Xing

  3. Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China

    Pui Shan Ho & Man Tong

  4. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China

    Cecilia Au, Wai Man Ling & Maggie Chan

  5. Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China

    Mandy Chan & Suzanne S.S. Mak

  6. School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia

    Raymond J. Chan

  7. Princess Alexandra Hospital, Metro South Health, Brisbane, Australia

    Raymond J. Chan

Authors
  1. Marques S.N. Ng
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  2. Kai Chow Choi
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  3. Dorothy N.S. Chan
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  11. Maggie Chan
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  13. Raymond J. Chan
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  14. Winnie K.W. So
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Contributions

Marques S.N. Ng, Weijie Xing, Raymond J. Chan and Winnie K.W. So contributed to the conception and design of the study. Data were acquired by Pui Shan Ho, Cecilia Au, Mandy Chan, Man Tong, Wai Man Ling, Maggie Chan and Suzanne S.S. Mak. Marques S.N. Ng and Kai Chow Choi analysed the data. Marques S.N. Ng, Dorothy N.S. Chan, Cho Lee Wong and Winnie K.W. So interpreted the data. Marques S.N. Ng wrote the first draft of the manuscript. All the other authors critically reviewed and revised the manuscript. All authors had read and approved the final version of the manuscript.

Corresponding author

Correspondence to Winnie K.W. So.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Joint CUHK-NTEC Clinical Research Ethics Committee (reference number: 2018.456) and the institutional research boards of the study sites.

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All patients provided written informed consent.

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All patients provided written informed consent.

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Ng, M.S., Choi, K.C., Chan, D.N. et al. Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients. Support Care Cancer 29, 6109–6117 (2021). https://doi.org/10.1007/s00520-020-05962-4

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