USA: For most cancer patients, the uncertainty and stress that can come with its treatment is compounded by what is now known as "financial toxicity", suggests a recent study. An earlier research demonstrates how a survey can measure a patient's risk for and ability to tolerate financial stress.


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With data from 233 patients going through treatment for advanced cancers, the researchers showed that the COST (Comprehensive Score for financial Toxicity) questionnaire identified patients at financial distress, which was found to be a "clinically relevant patient-centered measure."


Study's lead author Jonas de Souza said, "As expected, we found a strong association between a patient's use of health care resources and his or her sense of financial toxicity." Adding, "This is something we need to look for, to recognize early and make sure it does not become a barrier to care." More than two admissions to the hospital, had a significant impact on a patient's sense of financial toxicity. "This is reasonable. Hospital care is much more expensive tha office-based care. We now know that it also impacts a patient's self-reported financial feelings," de Souza said.


The research team kept the COST questionnaire short and simple. It includes 11 brief statements about costs, resources and concerns. For each question, patients were asked to circle one of five possible responses that help determine their level of concern. Exposed to statements such as: "I feel financially stressed," or "My out-of-pocket medical expenses are more than I thought they would be," patients had to choose the answer that best described their situation. The questionnaires revealed several factors that were closely tied to financial toxicity.


Employment status was at the top of the list, followed by household income, psychological distress, the number of hospital admissions, and race. African-American individuals tended to have more financial toxicity, on average, than Caucasians. One surprise was the lack of a perceived financial benefit from participation in clinical trials.


"Usually the maker of an innovative device or the company that supplies a new drug will pick up the costs related to the investigational drug. But that did not reduce our patients' sense of financial toxicity. We've added that to our model," he said. The next step is to go back to our patients and understand the factors that drive financial toxicity for each kind of cancer. "


Then we need to learn how to intervene. How can we help these patients, perhaps with financial counselors? And how can we decrease the costs of what we do to treat cancer overall and, at the same time, lessen the financial burdens that fall on the patient," De Souza said.


Adding, "It's important to note that the financial distress identified by the COST scale captures a unique set of stressors affecting patients above and beyond the physical and psychological strains of their disease," notes Lauren Hersch Nicholas, PhD, a health economist at the Johns Hopkins School of Public Health and member of the study team.


"Being able to quantify this burden is an important step towards giving patients, their families and care team the information necessary to make the best treatment decisions for each patient's situation." The survey was published in Cancer journal.